Tuesday, May 28, 2013

SUFFERING IN SILENCE: Female Sexual Dysfunction (Part I)

By Rachel Hercman

Rachel Hercman, LCSW is a psychotherapist specializing in relationships.  She works at the Medical Center for Female Sexuality in New York (www.centerforfemalesexuality.com), a center that provides cutting-edge medical and psychological treatment for female sexual dysfunction, where she helps women improve their body image, sexual functioning, and relationship satisfaction.  She can be reached at Rachel@centerforfemalesexuality.com

For a married woman, the ripple effect of vaginismus can exceed beyond just the bedroom.

Female Sexual Dysfunction 

Sara* was a beaming, exuberant bride.

After all those hopeless Shidduch dates, meeting Dovid* was the answer to her fervent prayers and she was overwhelmed with gratitude at how much they connected. He was truly worth the wait.

The wedding was everything she dreamed of, plus more. But as Sara and Dovid joyfully left the hall to go to a nearby hotel, some fears started creeping up. Though Kallah classes had been inspiring and her Kallah teacher was open and understanding, Sara had typical wedding night jitters when she thought about developing a sexual relationship. However, she found comfort in knowing that Dovid had a very gentle personality and always had her feelings in mind. Moreover, many of her married friends said they had had similar jitters about the wedding night, and since they became pregnant soon after their weddings Sara presumed that their experiences with the infamous ‘first time’ were a gateway to something better.

Unfortunately, Sara’s ‘first time’ became the start of many attempts to have a ‘first time’. Dovid called his Rav after Sheva Brachos to discuss their inability to consummate the marriage due to feeling like he was ‘hitting a wall’. After an extensive conversation, his Rav surmised that Sara’s vaginal muscles were too tight and he recommended that she take baths, practice relaxation exercises, and drink a glass of wine before intercourse. “Don’t worry”, he kept reassuring Dovid, “plenty of couples have this issue and with time it will correct itself”. But the weeks turned into months, then years, and Sara and Dovid felt like their entire relationship was stunted from reaching its full potential.

Dovid was loving and kind, but Sara felt alone and broken. She didn’t feel comfortable confiding in her mother about her sexual challenges and she was too embarrassed to call her Kallah teacher. After all, she felt like she failed as a student. She was taught that initially sex can be painful, but that with time it would evolve into an enjoyable, spiritual part of her marriage. When that didn’t happen, she began to feel like something was very wrong with her, and it only got worse when she would attend Simchas and feel curious eyes scanning her stomach.

If only she could get over this hurdle, she prayed, she could feel like a normal person…..

*Names and small details have been changed to maintain anonymity

Meet vaginismus, a type of female sexual dysfunction that contrary to popular belief, is not ‘all in your head’. Vaginismus is a condition in which the vaginal muscles involuntarily contract, making penetration painful and sometimes impossible. In its mildest form, a woman can tolerate penetration for very short periods, but it's unpleasant and painful. Or it can be so severe that she can't even touch herself near her vagina, can't have a gynecological exam, and can't insert a tampon because the pain is so intense and the fear so great.

In cases of primary vaginismus, a woman has never been able to have penetrative sex or experience vaginal penetration without pain. Secondary vaginismus occurs when a woman who has previously been able to achieve penetration develops vaginismus, and this may be due to (but not limited to) physical causes such as childbirth, infection, cancer, or even menopause. In both primary and secondary cases of vaginismus, the physiological and psychological factors are not only relevant but can sometimes play off each other, leading to exacerbation of symptoms. Thus, when a woman suspects that she may be suffering from vaginismus, it is essential that she have a comprehensive assessment that takes into account her emotional and physical symptomology. (For more information on vaginismus and painful intercourse click here.)

Suffering from vaginismus is painful from all perspectives; physically, psychologically, religiously, and socially. Here at the Medical Center for Female Sexuality, we often meet strong, successful women who share the heartbreaking feeling of being “broken”, “defective”, or “less of a woman” because of their vaginismus. As seen in Sara’s case, our patients with vaginismus often reflect on their suffering as casting a dark shadow not only on the marriage, but on their whole self-concept and identity. Feelings of inadequacy, incompetence, and isolation are commonly reported, and with time these feelings often intensify if the vaginismus is not treated.

For a married woman, the ripple effect of vaginismus can exceed beyond just the bedroom. For some husbands, the notion of ‘inflicting’ pain on their wives via intercourse is so upsetting that it can affect their own confidence and sexual functioning, and distance may ensue as both spouses associate their sex life with pain and negativity. Many couples we treat will share that they have become less physically affectionate altogether; the other day a patient tearfully shared that at this point in her marriage, she won’t even hug or kiss her husband and she feels terrible for it. She knows it hurts her husband and makes him feel unwanted and unloved, but she is scared that touching him may send the wrong message that she is interested in having sex. For this couple, as well as so many others we treat, they have adapted to the sexual dysfunction by living like roommates; respectful to each other, set in a familiar routine, but feeling a significant void.
Fortunately, there is wonderfully effective treatment for vaginismus, but many women do not end up getting the appropriate help until significant time has passed and the emotional pain is that much greater. Because vaginismus is often a private struggle, many of our patients breathe a sigh of relief upon learning that they are not alone in their suffering, it’s not all in their head, and there is hope in eliminating the pain.

In Sara’s case, a problem that went on for years was able to be rectified in just a few months and she was able to finally enjoy the sexual connection that her marriage had longed for.  While it took some time to adjust to having a sexual relationship after being so accustomed to its absence, Sara felt a surge of unprecedented optimism.  After years of isolation, she felt reinvigorated in her whole outlook on life.  She felt excited about her relationship with Dovid. She could smile as she looked ahead to their hopes and dreams for their future together.  And she could finally feel comfortable with her body and its wonders.

In our next article, we will be exploring some of sociological, cultural, and Halachic factors that come up for frum women suffering from sexual dysfunction.

Sunday, May 12, 2013

From Abuse to Awareness: Healing Through Motherhood

By Anonymous

From Abuse to Awareness: 
Healing Through Motherhood
By Anonymous

Baby Rochel. My infant daughter is a replica of me. I look into her deep eyes and see straight into her soul. To my soul.

I gaze at her adoringly, this beautiful baby, and I wonder if I was ever this loved, this cherished. I'm sure that I wasn't.

My formative years were neither kind nor peaceful. Abuse was endured, both physically and emotionally, and my earliest memories include pain and fear and terror. I believe that my parents did their best, with the limited tools they had. I have no doubt that they loved me in the way they knew. I have made peace with the physical aspect of this journey my soul chose, yet I would look back at my youth and feel abandoned by my heavenly Father. Was He not witness to my suffering? Was that little, innocent girl not worthy of His refuge?

I love my children with abandon, but that hasn't always been so. When my older ones were younger, I was afraid to surrender to those feelings. After all, maternal love did nothing to protect me. With a lot of effort and support I have learned to let go of that which doesn't serve me. I have learned to trust myself, my intuition, my mother-love.

This sweet baby has heightened my awareness. Her arrival has brought me to a much deeper level of sensitivity. In some ways I feel more fragile than ever, but in truth I am strong. Strong enough that I am no longer afraid of my feelings. I embrace the sadness, the pain, the joy. My vital essence regenerates; it reconnects with its source.

Awash with forgiveness and compassion, I find a much more peaceful self. I can push past my comfort zone, take unfamiliar routes, welcome the unknown and unexpected, all without the torment that would previously accompany a venture outside the realm of safety.

Baby Rochel, with her special soul, she brings healing to her loved ones. Through parenting this precious gift, I feel as though I have a unique opportunity to reparent my own inner child, and in doing so, I experience G-d’s ultimate compassion for His beloved children.  I have the pleasure of making my own acquaintance on a deeper, more intimate level, and I am slowly learning to love and cherish myself.

Sunday, May 5, 2013

G-d's Birth Control

By Chaia Kessler

"Looking back at our struggle, the 6am doctors appointments, the drugs, the thousands and
 thousands of dollars in medical bills, it all doesn't seem so bad."

God's Birth Control
By Chaia Kessler

I am your sister, your daughter, your friend, your neighbor, that person you make eye contact with in the grocery store but don't actually know.  I am that person in your life that has been married for years and doesn't have children.  Some of you may know the feeling that consumes your entire body when you get handed your baby for the first time. The warmth, and love you already have instilled in you from the months of having them with in you. Some of you may know the feeling of losing a pregnancy, the feeling like a piece of your heart is missing and may never return. Some of you may know the feeling that month after month there is only one line, the feeling like you are empty inside. That feeling is G-d's birth control.

Everyone has their own struggles that they need to overcome. For a lot of people its finding the one. The shidduch scene, the dating. As my friends know I was never much help when it came to giving advice, because I was never in it.  I was blessed with finding my husband when I wasn't even looking, knowing he was the one and getting hitched. But although I did get married before all of my friends, most became mothers before me. One shabbos when i was talking to a friend about her horrible experience with her last date I told her maybe you haven’t found the right one because Hashem doesn’t think you’re ready.Then it hit me,  Hashem hasn't made me a mother yet because I'm not ready to be a mother. It was like a weight was lifted off my shoulders. This friend however didn’t like what I said very much at the time. She just wanted to get married already. Two years later she got married to an awesome guy and at her wedding she smiled and whispered to me, "I wasn't ready."

So that is what I held on to. Knowing that G-d knows best and one day when he deems me ready I'll be a mother.  This is not to say I didn't get furious at him, often. But eventually I knew that I would look back and know that it was meant to be this way. Our Shliach, our amazing doctor that made our dreams come true once said to me."It's not an 'if' you get pregnant it's a 'when." I guess my point is if you believe something will happen and trust in Hashem that he knows the right time. So in that four years of waiting, I went to Israel with my husband, we bought our house and fixed it up ourselves, and we had four years of shona reshona and I can't thank Hashem enough for that.

A few weeks before our fifth anniversary my husband and I gave birth to our beautiful, healthy twin boys. After being married for over four years G-d took me off his birth control. Looking back at our struggle, the 6am doctors appointments, the drugs, the thousands and thousands of dollars in medical bills, it all doesn't seem so bad. I remember the feelings I had when I was going through it all, but now all I have is love.

So these beautiful, smart, funny baby boys are not just the next thread in my tapestry of life—they are the most beautiful, vibrant threads in my life. I know that if these boys are so brightly and intricately woven in my life, I'm sure I am as deeply woven into theirs. This gift and responsibility called motherhood, I know full well I am ready for because Hashem made it happen at the right time.

With every mess, dirty diaper, and sleepless night, all I can do is thank Hashem. For not just blessing me with a child but with twins.  I hope my boys grow up being the closest and best friend a person could ever wish for. I hope that they grow up knowing their mother cried herself to sleep begging Hashem for them. I hope they know that they are their parents miracles.