by Naomi Wolf
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.
I pushed further. “How often do you hear that expression ‘I feel like damaged goods’ from your patients?”
“Almost with every person I see,” she replied. “It is almost impossible not to say that, it seems, at a certain point.”
“I feel,” I speculated, “that there is something about a sense of an intact, healthy vagina that goes to a core sense of the female self. Is that crazy?”
“No,” she assured me. “When your foot hurts, you may feel depressed; it doesn’t affect your core sense of self as when the vagina is injured or in pain.”
“Do many of your patients feel depressed?” I asked. I was wondering if vaginas that were not working well neurologically were not delivering dopamine to the patients’ brains, which would stand to reason.
“All of them feel depressed. All of them have depression,” she stressed.
“Do you think that the nerve damage in the vagina may be a physiological cause of the depression?” I continued.
“When there is pain to the vagina, your whole central nervous system gets affected. I am sure there are biological things going on.”
“How does this depression manifest in your patients?”
“It is like: ‘Why me? I’ve been a good person.’ ”
“It is existential depression,” I remarked.
“Yes. I see young women whose lives are shattered. It can happen from one moment to the next. They go from normalcy to severe pain.
“I had one patient,” she continued, “a businesswoman. The day before she was supposed to go on a business trip to India, she was struck with horrible clitoral pain. Her pudendal nerve became inflamed. She went on this trip to India nonetheless, and she was dying the entire time. She tried to put herself through the meetings. At the hotel she would put an ice pack between her legs and start to drink. She said that if she had spent the rest of her life like that, she would have killed herself. Most of my patients have had suicidal ideation.”
“You are saying,” I confirmed, “that this is different from patients of yours with equally severe pain elsewhere in the body. Is there anything else specifically about pain in the vagina that would make women especially want to kill themselves?”
“The inability to have normal intimacy makes it all the more desperate, though I have met really terrific men who are incredibly supportive.”
“What does it feel like for women to never be able to use their vaginas in a healthy way?”
“They don’t feel like they are whole.”
“In a different way than an amputee?” I kept restating the question because I wanted to be sure I was isolating “vaginal grief” from general physical grief.
“Yes,” she affirmed. “While I was going through my journey with vulvodynia, I also had a lateral mastectomy. That was a piece of cake compared to this. You feel unattractive, like your partner is not going to want to touch you. I have said at certain points [to my husband], ‘Why don’t you just go have an affair?’; I feel so bad that he cannot have typical intercourse. My clients have told me they said the same things to their partners. People worry about their partners leaving them. They don’t feel like whole women.”
I asked her whether there was any message regarding their vaginas she wanted women reading to know.
“Women have so little understanding of their own bodies—because the science is missing, I am finding,” she said. “The science is missing. If people had a better understanding of the biology of women, this area would be so destigmatized.”
“You are saying that modern science doesn’t distribute widely enough an understanding of women’s vulvas, vaginas, and pelvises, and so women do not understand themselves either?”
“Yes,” said Fish.
“So science is in the Dark Ages regarding the vagina, and so are women?”
“Yes. We are so in the Dark Ages when it comes to medical care and understanding in the area of the vagina.”
“I didn’t even know I had a pudendal nerve,” I commented.
“Oh my God! When I say ‘pudendal nerve,’ no one knows what I am talking about. People in the medical profession don’t know what I’m talking about! Women need to become more comfortable with their vaginas. When women first come to see Dr. Coady, no one has ever heard of the pudendal nerve, and they don’t know what pelvic floor muscles are, or that these are also connected to their vagina and can affect their sex lives. . . . Some women don’t know exactly where their labia are, or their clitorises. Deb always gives them a mirror.”
“What happens when women heal and can use their vaginas normally again?” I asked.
“It takes time,” she replied. “Some women will always have cautiousness there.” Fish explained that some of her clients said that even after they had recovered, they felt that their “sexuality was amputated.” “They have anxiety,” she went on. “They have hypervigilance there about everything they do.”
“So the experience of pain or trauma in the vagina, even after it is over, leaves women with some psychological scars—anxiety, hypervigilance,
a sense of ‘amputation’ of an aspect of the core self—that are hard to just ignore even after the vagina is ‘better’?” I asked. I thought again of all those women in Sierra Leone moving like ghosts in a settlement of ghosts; I thought of all the women I had met in Western Europe or North America who had been raped, and who were still moving through life with “the light,” as Jimmie Briggs had put it, having “gone out of their eyes.”
Did her patients, I asked her, report any general flattening of excitement, enthusiasm, or creativity when their vaginas were so—for lack of a better term—despairing?
“Oh yeah,” she confirmed with certainty in her voice. “Everything—everything becomes flattened: their feelings about work, their feelings about their friends, about their partners, about family members. Their perception changes because of the way they feel about themselves. They start to feel damaged, so they project it onto everyone else. It is indeed despair that they report: despondency and hopelessness.”
“Does anyone talk about a loss of creativity with vaginal injury? Did you yourself experience a loss of creativity?” I asked.
“When I am in really bad shape . . . yes, everything becomes hampered,” she said sadly. “I feel less creative about everything: about interactions with children, with friends.”
“Do people find when they get better their creativity and hope come back?” I pressed on.
“Yes . . . they do,” she mused. “Like any loss, the trauma stays with you on some level even after you get better. But hope, confidence, creativity—yes. When women start to heal, they do start once again to be able to appreciate things on a deeper level.” She was silent, thinking. “Hope, creativity, confidence . . . ,” she said, almost to herself, as she pondered again. “Their affect is much different,” she confirmed at last. “They begin to feel like a whole person again, not like damaged goods. Do they seem more excited, more hopeful?” she asked herself again, connecting my questions, which were new to her—as they were new to me—to her clinical experience. “Yes, definitely,” she said, after a long pause. “They can have intercourse again. Their confidence comes back. Once they do recover their sense of being intact human beings . . . they do get back a deeper sense of meaning. The things that seemed insignificant before, while they were suffering, can indeed become significant again: good things—the sense of connection to family and friends.”
“And that sense of connection to family and friends gets lost or damaged when they are suffering vaginally?” I repeated.
“Yes, it does.”
“What I am really teasing out is whether your clinical experience confirms what is right now just an intuition for me, with some science to hint in that direction.”
“I definitely think based on my clinical experience that what you are saying is very, very valid,” she said. “One treatment for chronic pain is SSRIs [selective serotonin reuptake inhibitors]. Of course your norepinephrine and serotonin are affected by pain. If those chemicals aren’t functioning properly—that is bound to affect your mood. Psychologically, chemically—definitely: there is a chemical alteration when there is any kind of vaginal or vulval-region problem; there has to be a chemical alteration in the female brain. Everything is connected; you can have pain there, then you can have peripheral nerve pain, then it can affect central nervous system pain. There is a whole mind-body connection—like a vicious cycle.”
“Your brain is connected to your vagina,” I restated, glad that she had confirmed, from her much deeper background, the possible link I was investigating.
“It definitely is,” she said.
“So let me take a giant leap now,” I said. “There are countries where all the women are put into vulvovaginal pain systematically through female genital mutilation, which includes cliterodectomy and infibulation. Would you say from your clinical experience that this would be putting most of these women into a state of permanent lack of affect, anhedonia (low ability to experience pleasure in general), and depression?”
“I don’t see how they can’t be. There has to be permanent damage to the pelvic nerve. There has to be psychological damage when somebody amputates that part of their body [Fish is using a metaphor; the pelvic nerve would be, rather, severely scarred]: the same things I am seeing, I imagine. Despair and hopelessness.”
“It is a reasonable hypothetical?” I asked.
“Oh yeah, it is reasonable.”15
“If I can show the implications of a brain-vagina link,” I mused, “well, it seems to explain so many otherwise weird things that are done to the vagina in history.”
The pelvic nerve of the vagina—which I am using interchangeably with “pudendal nerve”—in contrast to the pelvic nerve that terminates in the male prostrate, rectum, and penis, is terribly vulnerable, physically. It can be injured or irritated in childbirth, in episiotomy, and in many other less dramatic ways. The pelvic neural system in women is so delicately exposed to the environment, so lightly shielded by thin vaginal membranes, that in some cases a woman’s having merely sat for too long in the wrong position, placing pressure upon it, can injure the female pelvic nerve permanently. Dr. Coady made an important discovery that many women are suffering permanent or severe injuries to their pelvic nerves merely from yoga leg stretches, or from dance classes.
Because of the differences in male and female pelvic anatomy, the female pelvic nerve is of course far easier to attack and injure intentionally than is the male pelvic nerve. You would literally have to pierce a man through the perineum to do the same kind of damage to the male pelvic nerve that a violent rape or sexual injury can do to a woman.
Men would suffer from disruptions of delivery of opiate-type hormones to the brain, if they suffered injuries to their own pelvic nerves, obviously. And such injuries do happen—notably, in prison populations, where, it is well worth noting, violent male rape is widespread and accepted by authorities in a de facto way, and where inmates’ passivity is also valued. But these kinds of injuries to men, because of their more defended pelvic anatomy, are far more rare.
Does this insight about how damage to the pelvic nerve affects the female brain completely change our understanding of what rape is? It certainly should. In war, time after time after time, women suffer the insertion into their vaginas of blunt objects, of bottles, of bayonets. Gang rape rips them up at the site of the vagina and where the prostate would be, between vagina and anus—two of the three termini of the female pelvic nerve. In culture after culture, cliterodectomy is also practiced—cutting off and traumatizing the final terminus of the female pelvic nerve.
This has long been misunderstood as a sex crime. It is actually a technique.
RAPE STAYS IN THE VAGINA
Mike Lousada is the world’s nicest former investment banker turned male sexual healer. His mission, as he describes it, is the sexual healing of women, and he is highly trained both as a therapist and as a Tantric practitioner. He has a well-regarded practice in Chalk Farm, London, where he has sexually healed or sexually enhanced the responses of hundreds of women through a combination of Tantric gaze and touch, and orgasmic “yoni massage.” (Yoni is the Hindi word for “vagina”—it means “sacred space.”) Lousada is one of a growing number of practitioners from various disciplines who are certain that the vagina mediates female emotions and thoughts. His success rate has been so consistent that he has begun to address mainstream British and international medical panels of physicians who treat low sexual desire and sexual dysfunction in women, and Dr. Barry Komisaruk, the MRI/female orgasm researcher at Rutgers, has contacted him to study his practice with MRI machines.
Outside a small library at a medieval college, I Skyped with the man whom I was starting to think of as a resident adviser for all things yoni.
I had met Lousada a year earlier, when I had interviewed him for a London newspaper about his yoni massage work, and I wanted to ask him now about his views on what Dr. Richmond had reported to me, and about the questions raised by the recent scientific reports on t
he effect of rape on the female body. Does sexual trauma stay in the vagina in a physical way, in his experience? He had worked intimately with the vaginas of so many women, many of whom had experienced some kind of sexual trauma. What would he say?
I sat on a low ledge that was part of an ancient wall at the edge of the green in the center of the college. It was early June: heavy pink heirloom roses scented the air, shedding petals along the path to the small stone library. Clusters of pale cherries, not yet ripe, hung from the boughs of a massive tree at the corner of the green. These were not the dark-crimson American cherries I was used to, but Shakespeare’s buttery-rosy English cherries—a common metaphor in Elizabethan poetry for lovely cheeks or lips, or for the general deliciousness of women.
I was on my second vagina guru of the day, and it wasn’t even lunchtime.
Earlier that morning I had been studying in another library. At the university where I had been working, scores of students had been silently focused on reviewing their Swinburne or Lawrence. While trying to open a document on my laptop, I had inadvertently pressed “play” on an audio file of an interview I’d conducted with Charles Muir, the American Tantric guru. Muir was the man who claimed to have brought awareness of women’s internal “sacred spot” to America in the 1970s. Suddenly, in the silence of the library, a Queens-accented, resonant voice had rung out clearly from my computer: “There are trillions of cells in one ejaculate. A typical man ejaculates with so much force that . . .” Rows of curious faces had swiveled toward me simultaneously. I’d frantically tried to press “stop,” tapping the trackpad over and over, but Muir’s confident cadences grew only louder. “And every time he ejaculates . . .” Finally I seized my computer and, red-faced, carried Charles Muir’s voice at a run out of the double doors.
Now it was Lousada’s voice, softer and London-accented, that my computer broadcast, as I asked him whether, in his experience, he had seen any physical markers of sexual trauma in his clients. Dr. Richmond and others had shown how trauma to the vagina can leave a mark on the brain and nervous system. Now I wondered if, in the feedback loop that characterized the brain/vagina connection, memory of trauma might leave a physical imprint on the vagina.