I started reading, Come As You Are by Emily Nagoski. This follows reading Esther Perl and Harriet Lerner. Like Esther Perl, this book deals with sexual function, relationships, aging, etc.
Something that I’ve been reluctant to write about is my sexuality and its functions and dysfunctions.
I cannot say exactly when I stopped being interested in engaging in sex, but at the very least it has been since my pregnancy with Eliot. During the pregnancy I had virtually no desire. For me I attributed that to not just the hormones, but also to the excessive weight gain when I topped the scales at 185lbs; all of my adult sexual experiences had occurred after I lost my high school/early college weight. Being fat felt incredibly unsexy to me.
After having Eliot things in my body shifted. I had several vaginal rips that resulted in scar tissue, but the biggest difference I was that my uterus went into retrograde – kind of like some astrological maneuver, right? Actually it just meant that the angle created between the vagina and the uterus inverted. The end result, two things: it seemed I could no longer achieve an orgasm vaginally and deep penetration hurt.
Now pile on the stress of having a baby and two puppies, staying home with said infant instead of working, and then after going back to work, starting graduate school. Not exactly a recipe for desire.
Then the infertility years hit. Three years where sex was about making a baby, daily injections, artificial insemination, pregnancy losses, hormones galore, and procedures for extractions. By the end we didn’t even have sex to make the last couple of babies.
After Auden it all fell.
I don’t mean my emotions – I mean my girl parts. Cystocele, rectocele, prolapsed uterus: my vagina was now a very crowded place and my bladder, rectum and uterus were all trying to come out of it. So, physical therapy, which is way more than just Kegeling – but in the end, that only helped a little bit, because muscle strengthening does no good whatsoever if the pelvic floor muscles are attached to ligaments attached to nothing at all.
So I got a pessary. Do you know what a pessary is? It’s a silicon ring that you shove into your vagina to keep your insides from coming outside. You want to know what else it did for me? Very special. It raised my bladder up enough that it straightened an apparently, until then unnoticed kink in my urethra. [I know the sound of a kinky urethra sounds good, doesn’t it?] Well, who knew that fixing that problem would reveal a new one? The first time I rode a bike with my pessary in, I discovered that I had stress incontinence. Yes, you got it, I exerted effort – like a down pedal – and pee escaped my urethra. I became one of the thousands of women trying as discretely as possible to purchase Poise pads in the checkout line at Target. Ok, who am I kidding, at this point I had no dignity left. There was no discretion. I piled the packs of pads on the conveyor belt.
Much like infertility – I found that as soon as I started telling people about dealing with my gynecological issues – while some were appalled that I would bring the topic up over dinner or at work – a number of people pulled me aside and confessed that they, too, had problems. Go figure. Short of surgery, there really wasn’t anything to do about it, but live with it.
I’d like to just pause here for a moment to speak kindly to myself. I know that many women struggle with their post-partum bodies, and I believe that whether it’s dealing with the stretchmarks and sag or the complete ruination of your genital area, none of it should be dismissed. Our sexuality is a huge part of our identity. I’m not the first person to address the loss of body and sexuality to motherhood – your breasts to your infant – your vagina to an episiotomy. But, just writing this all down, I realize that I was royally fucked up by pregnancy and labor. I wore pads every day and cringed every time I sneezed because I peed a little. I wore a big silicone ring that needed to be removed if I wanted to have sex. But the best part, if I actually wanted to have sex, I could pretty much guarantee it was going to hurt, and there was little chance I was going to orgasm. Now, I’m not a behavioral scientist, but I have read about Pavlov. It seems kind of obvious to me now.
But wait, I have to tell you, it gets better. Oh, and I don’t mean actually better. In early 2014, I had to have my gallbladder removed. There were a few complications, and I stayed in the hospital in excruciating pain not eating or drinking anything for 10 days with pancreatitis. As you can imagine there were a lot of medical bills, but fortunately we had insurance. That summer my GP made what I think was a very reasonable and rational comment based upon a conversation I had had a year or so back – she wondered if maybe I should speak with a urogynocologist about surgery. Her reasoning was I had met all of my insurance deductibles for the year. It was just a comment, not strongly suggested, but it made sense to me. So I did. And I met perhaps the most approachable, attentive and intelligent urogynecological surgeon I could have asked for. Wonderful woman. In December of 2014, I had a hysterectomy (uterus, tubes, cervice – leaving my ovaries), a sutured suspension of my bladder, vagina and rectum, and a mid-urethral sling for the incontinence.
After the surgery, I was able to toss my pessary and my pads – both menstrual and incontinence. Of course, something unexpected happened. I couldn’t pee anymore.
Weeks of self-catheterizing, UTIs, visits back to the surgeon followed. Eventually the muscles relaxed enough that I need not catheterize, and I could pee but not completely empty my bladder. This led to more UTIs and measuring every urination in a toilet hat as well as recording volume intake and outtake in a voiding diary. It’s now September 2015, and I am still seeing a physical therapist because, as she has observed my pelvic floor muscles have PTSD. They are beyond fatigued but still completely engaged unable to relax.
Oh, and sex with Sandy – still hurts. And yet I constantly feel guilty for not wanting to have sex.
I’ll admit – it is far more complicated than this. There are numerous other factors involved in my interest in sex that I will not yet address. But what I am reluctant to state, for shame, is that I actually do have a libido. I masturbate regularly – often daily.
Reading, Come As You Are, I’m only in the second chapter, but I begin to understand how this is possible.
She describes the Dual Control Model developed by Janssen and Bancroft at the Kinsey Institute in the 1990s. The really boiled down premise is that our central nervous system controls many things including sexuality with a dual set of controls – in this case, a Sexual Excitation System (SES) that controls the “accelerator” of your sexual response and a Sexual Inhibition System (SIS) that represents the sexual brake. It is possible to be completely excited and then have a brake halt that desire; she offers the example of your grandmother walking in on you during sex, but it can be far more subtle than that. People can have high to low SES or high to low SIS tendencies and in variations. Someone with high SES and low SIS may be easily aroused and show little restraints. Someone with low SES and low SIS may take a while to warm up, but can have a lot of fun. Someone with high SIS is most likely to have sexual dysfunction. There is much more to be explored here, but I can see that with Sandy my SIS values are likely quite extreme. A lot of screeching brakes.