Something I don't think we talk enough about is sex, love, and connection and how it can heal traumatic and painful experiences. It can even lessen chronic pain and pelvic pain. I believe that understanding the different states of our nervous system, including Stephen Porge's Polyvagal Theory, can connect the dots of how pelvic pain and chronic pain are driven by our emotional state, unprocessed trauma, and deeply stressful experiences.

Polyvagal Theory is neurobiological evidence based on how nerves are connected to our brainstem and pelvis. Everyone's pain triggers are bio-unique, but if you are suffering from chronic pain, there is a likelihood that you need to balance your nervous system and nurture your pelvis. 

Pain receptors don't exist, which is important to understand when dealing with chronic pain. Instead, the brain receives messages from sensory receptors that have experienced changes in temperature and pressure. The brain then decides what to do with these changes and whether they require action. The brain uses the nervous system to communicate with the rest of the body that there is danger and if you are suffering from chronic pelvic pain, it is likely that your body is on high alert and receiving a whole host of signals that are not accurate or necessary. 

To decipher how this happens and what the brain perceives as 'safe' or 'unsafe,' the vagus nerve is arguably the most important nerve in controlling our body's state. Porge's theory says that when faced with a neuroception of threat, the nervous system will shift as arousal increases. For example, the body may sit in the ventral-vagal system (a state of rest and digest) before shifting to the sympathetic (a state of arousal showing up as fear, panic, and anxiety) and then into the dorsal-vagal system (a state of hyperarousal which shows up as immobilization, fear, and numbness). 

To that end, unprocessed energy from trauma can get stuck within the body. This unprocessed energy can be considered a threat by the receptors in our body, communicating to the brain that something is not right and the body is in danger. Essentially our nervous system is on high alert when it’s not meant to be.

Our autonomic nervous system constantly appraises cues from the environment through a process of neuroception. If you have an overactive sympathetic nervous system due to persistent pain or trauma, the body can default to this state and drive the pelvic pain response. 

Here is how the pain cycle works: 

• Repeated trauma shifts your body into a state of vigilance and the body releases cortisol.
• The amygdala in the limbic system trips the alarm to alert danger.
• The thalamus instructs the brain stem to release neurotransmitters which increases blood flow to the larger muscles in the body, preparing you for fight or flight.
• The stimulation activates the sympathetic nervous system and the HPA axis increases cortisol in the body.
• This calms the hippocampus (the part of the limbic system that regulates emotions), which in turn creates more cortisol and stress release.
• The hypothalamus then tells the pituitary gland to release more cortisol and epinephrine. Epinephrine increases the heart rate and suppresses your immune function.

Long-term activation of the sympathetic nervous system increases the amygdala’s response to danger and this can lead to a condition called central sensitization. It increases the sensitivity of the amygdala, making it susceptible to considering almost anything as stress, including past memories, unprocessed trauma, and experiences that are still looping around your body. This can cause chronic pelvic pain and lead to ‘always-on’ anxiety. 

‘Always-on’ anxiety is likely to lead to chronic activation of your psoas muscle, the muscle that connects the lower spine into the pelvis and down to the femur. When this contracts, it can exacerbate these cycles. If your psoas is contracted, it is likely that you may experience contractions in your entire pelvis area, including your glutes. Tensing, breathing in, sucking in your stomach, changing your posture, and holding it in unnatural ways can also add to chronic tightening of the psoas muscle. Even tightening of the voice box can be connected to tightening of the pelvis.

Starting to re-write these pain loops and reduce central sensitization of the nervous system is possible, but it requires deep work physically, emotionally, and sometimes spiritually. Some therapies to explore are EMDR to remove trauma from the system, breathwork, and movement. Talk therapy, too, can help you shift into a state of forgiveness for yourself and those around you. 

Additionally, connection and community can help calm your nervous system as you move through this journey. Building intimately safe relationships are really important because they can shift your body into a state of safety, which means that you are more likely to engage in sexual activity and intimate moments. Sex is actually a natural painkiller. It triggers the release of endorphins in the body, which reduces pain and stress. Studies show that during sex, sensitivity, discomfort, and pain in the body decrease as well. This is because of the changes to hormone and neurotransmitter levels within the body that we experience when we have sex and experience pleasure. Sex is also great for your pelvic floor (both through arousal and orgasm) because it brings healthy blood flow to the area, including the tissues, nerves, and muscles.

If you’re on this journey, I’d love to hear what’s worked. Chronic pain can be challenging for many, so it’s incredibly beautiful when you find something that can help alleviate it.

***THESE STATEMENTS HAVE NOT BEEN APPROVED OR REGULATED BY THE FDA. WE ARE NOT DOCTORS, THEREFORE ALWAYS CONSULT WITH YOUR DOCTOR FIRST****