I want to want my husband of 20 years. He’s tall, smart, kind, and blisteringly handsome in an Ichabod Crane way, which is the way I like. We were hot and heavy in our early days, ferrying across the Puget Sound to meet up and make out at various bars, sleeping over, reaching for each other in the middle of the night and in the morning, never quite getting enough.
But eventually, two babies and the freight train that is menopause hit. Truthfully, it is only in retrospect that menopause feels like tons of twisted metal has knocked me over. In reality, the metamorphosis from “40 and Still Feeling Cute” to “50 and Way Past My Prime” was slow, insidious and confusing. One reason for the mystery of “Am I menopausal or am I not?” was an endometrial ablation I had a decade ago ― a procedure that destroyed my uterine lining to prevent suffering through monthly menstrual bloodbaths. The results were miraculous, but prevented me from knowing exactly when I was going through the great comedown.
My main clues were insomnia, which I’d always had issues with anyway, and painful ― harrowing ― sex that caused my husband to feel guilty and me to sink into a pit of intimacy avoidance.
I was not ready to accept this punch to my marriage or my identity, so I decided to ask my gynecologist for a referral to a pelvic floor physical therapist. I’m not sure where I learned of this option or what exactly such a PT could do to help, but with the referral in hand I ... did nothing. Each year I went to see my OB-GYN and asked her to re-up the referral. But I continued to slow-walk my way to nowhere. Meanwhile, my libido was atrophying and sex hurt more than ever.
Finally, I made the appointment and was assigned a physical therapist, Kaeli Gockel, who seemed to be in the prime of her own reproductive years but somehow possessed an old-soul compassion for middle-aged women scrabbling with where we now fit into society.
One of the first things she addressed was the pain-mind connection. She explained that once the brain senses pain in a particular area of the body, it becomes more alert to danger from the next injury. In fact, your body can produce nerve endings where pain occurs or where it expects pain. In my case, my vagina must have shot out new pain receptors like tiny fireworks. This meant deep breathing and re-teaching my body that it could trust me to stop any activity causing vaginal discomfort.
Another goal was to keep my vaginal walls supple by stretching them, which was surprisingly necessary even after birthing two nearly-10-pound babies in the Aughts. I was instructed to order pricey silicone dilators in varying sizes, and Kaeli taught me how to use them ― inserting and pressing in a semi-circle as if I was moving from the 3 o’clock to 9 o’clock positions. We discussed urinary incontinence and flatulence as matter-of-factly as if we were discussing traffic or how we take our coffee ... or farting while sitting in traffic drinking coffee.
Early on, we looped my gynecologist back into the process of revamping my nether region. She agreed to prescribe estrogen cream, which I have to messily insert two to three times a week with the goal of moistening tissues and making them “bouncier.”
“I remember a male friend once describing my son’s teacher scornfully as 'post-menopausal.' That, among other remarks I’ve heard excoriating mature women, left an impression.”
Sadly, for me, menopause has caused a fair amount of shame. My skin has gathered into dry furrows and tucks. I reach for lube but instead of a fun enhancement, it’s a necessary tool. I remember a male friend once describing my son’s teacher scornfully as “post-menopausal.” That, among other remarks I’ve heard excoriating mature women, left an impression. For this, Kaeli recommended mindfulness guided meditations as well as checking out artist Jamie McCartney’s “Great Wall of Vagina,” which showcases his sculptures of more than 400 women’s genitalia. See! Vaginal abnormalities are actually normal!
As the climax to this process, Kaeli invited my husband to come to an appointment. An excellent sport, he accepted the invitation. For the first time since I started seeing her, I was nervous. Would we have to do this with the lights fully on? Would he be disgusted? Would he still want to attempt sex with me after this? With Kaeli’s patient coaching, though, he learned how to help me with the dilators, and the session went well. My husband even seemed grateful that we’d included him.
After all of my work, Kaeli suggested I buy a sex toy for myself, as a treat. I’d only ever been gifted sex toys before, and those were based on what my boyfriend at the time or husband thought I’d want, so I splurged on a clitoral vibrator. Let’s just say that it makes me forget my aging body, bright lights, or even what planet I’m on.
Nothing about this pelvic floor physical therapy has been inexpensive or easy. And I’m still not 100% pain free when having sex, but I feel like I’m getting there. Still, I recognize how fortunate I am to have the time, money and insurance to address these issues. This shouldn’t be a privilege afforded to a select few ― everyone should have access to whatever they need to create a healthy, happy sex life.
I recently found an Instagram post by Dr. Sara Reardon, a pelvic floor physical therapist, that eases my guilt surrounding the currency of both health insurance deductibles and time I’ve spent rehabbing my sex life. In the post, she responded to a physician noting that pelvic floor physical therapy is currently trendy. “Pelvic Floor PT is not a trend. It’s an integral part of healthcare that has been overlooked and underutilized for too long,” Reardon’s post says. And Kaeli, my PT, says, “My dream is that someday everyone will have easy shame-free access to pelvic health and sexual wellness. I really believe we can’t have true equality until we have orgasm equality and we can’t achieve that until painful intercourse is taken seriously by insurance companies.”
It took me 19 years after the birth of my first child to finally visit a pelvic floor physical therapist and whatever bumps (plus hopefully bangs and slams) I encounter on the road to good post-menopausal sex, I am, at the very least, doing my best to keep it all going.
Angie McCullagh is a Seattle writer with work in The Independent, The Sun Magazine, Wired, Writer’s Digest, and various other outlets. She lives with her husband, mutt, and two teens. Follow her on Twitter at @Angiehiseattle.
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