For many women, pelvic sensory awareness is especially challenging. When beginning pelvic floor therapy, it is common for their nerves to misinterpret muscular trigger points as a bladder urge, or constipation/bowel fullness. They may even have difficulty identifying where pressure was applied to their muscles. It can often feel as though their nerves whispering so they can't understand what they are saying. Sometimes if even feels as though their nerves are flat out lying to them. While this can be frustrating, it doesn't necessarily mean that their body is broken.
The nervous system is amazing in its ability to identify diverse sensations of temperature, light vs. firm pressure, vibration, sharp vs. dull touch, and pain. Our sensory awareness, however, requires fine tuning. Children are continually seeking to experience different textures, see different colors, and explore new things. This is crucial to developing their nervous system.
When it comes to female pelvic health, there are often some sensory speed bumps that women encounter which can slow the development of their sensory awareness. Let's take a look at the development of pelvic sensation and coordination in women.
Pelvic Sensory Awareness in Females:
3.) Menstruation
Potty Training: Bowel/Bladder Urge Awareness
When it comes to the pelvis, developing sensory awareness is complicated. In our early development, our bodies have very little awareness of our pelvis. We face our first pelvic awareness challenge as toddlers when we start potty training. The first step in being able to potty train is for the child to understand and identify the sensation of a full bowel or bladder.
As children start showing signs of an awareness that they need to empty their
bowels or bladder, such as running away and hiding behind the couch to poop, we know they are starting to feel what is happening in their pelvis.
This initial phase is fairly similar for children whose sex assigned at birth is male and female. After children develop that awareness, the process has some significant differences.
Toilet Hygiene Related Touch
Due to the anatomical nature of male and female bodies, male children are taught to hold their penis and direct it into the toilet to urinate. This introduces a sensory awareness experience that is very different than that of female children. While male children are directed to touch their genitals, female children are not.
This is a practical difference in the way we raise children, and doesn't have any sociocultural motivations around sexual function. While this is intended as a practical lesson in cleanliness, it establishes early a different foundational relationship with touch. Males are exposed to neutral touch of the genitals. It is normative for them to touch this part of their body on a daily basis. Females on the other hand, are taught to avoid genital touch. Female children experience external genital touch only through wiping with toilet paper, and not direct contact with their hands.
A child's hands and their mouths are their primary sensory tools for interacting with the world. Children generally are curious to touch new things that they see as they explore the world. Our hands are an important tool for our bodies to build an understanding of the world around us.
It is common that parents discourage both male and female children from external genital touch in public. Males are taught not to adjust their testes in front of other people (though many continue to do so discreetly even in public settings). Females are taught that scratching their vulvar region (commonly referred to as "the crotch"), is also not appropriate in public.
Due to some basic differences in toilet training, genital touch for females typically does not occur as frequently. Internal genital touch especially, may not occur for a longer period of time. Generally speaking, children are taught not to stick their fingers into the holes in their bodies. Parents discourage kids from picking their noses, and sticking their fingers in their mouths, etc. Although some female children do engage in self-exploration of their vagina, many do not. Those that do engage in self-exploration are frequently discouraged from doing so by their parents and caregivers.
Menstruation
For many females, their initial experience with internal vaginal touch occurs at puberty. As females begin menstruation, inserting a tampon is often the initial introduction of internal vaginal sensory stimulus.
Consider for a moment that this is happening at a time that most females are experiencing pain. Pelvic cramping associated with menstrual cycles serves to distract the nervous system from sensory processing due to pain and discomfort. The bloating that can occur with menstruation also applies some pressure to the nerves. This added pressure/constriction can also impact the ability of the nerve to send messages for sensory processing efficiently.
Social factors further complicate the situation. As their bodies are growing and changing, puberty can be an awkward time for kids developmentally regardless of their biological sex. This isn't an optimal environment for the body to fine tune its sensory processing awareness.
Gynecologist Examination
Medical sensory introduction of internal vaginal touch is often just as complicated. The first trip to the gynecologist is often an anxiety producing experience (coming soon: Tips for Your Daughter's First Gynecology Visit).
If a female is not having menstrual problems, this may not occur until the age of 18, especially if she is not sexually active. If she is seeing a gynecologist sooner, it is often because of menstrual problems, or for pregnancy prevention. In the event of menstrual problems, that female's introduction to medical related touch of her vagina is precipitated by the idea that there is a problem. This can further negatively impact her sensory processing development.
If her first trip to the gynecologist is for pregnancy prevention due to sexual activity, there are many sociocultural factors at play which complicate the experience. Processing the emotional, social, and physical implications of sexual activity is complex. As a female tries to process all of these things at once, it isn't an ideal environment for sensory learning. Most people learn better when they are able to focus on a specific task. Asking a female to learn to develop good pelvic sensory awareness in this context would be similar to asking her to learn math, while sitting in a classroom with a math teacher, a science teacher, and a music teacher, all trying to give her instructions at the same time. None of us would be surprised if she left the classroom without a very good understanding of any of the three subjects.
Sexual Touch Introduction
It is difficult to discuss to full complexity of this topic at length here. Introduction of sexual touch for females can occur either by self-touch, or touch by another person. There are many implications for both contexts.
A person's thoughts and feelings about sex are not developed in a vacuum. Females are exposed to a variety of ideas based on their family's belief system, and their culture. Most females are exposed to opposing views. They are told by some that sexual desire and activity is normal, natural, and should be completely without restrictions. They are told by others that there are very specific contexts in which sex is appropriate and inappropriate.
For most females, these conflicting views create a certain amount of dissonance. It often feels impossible to be at peace with their decisions about their sexuality because they cannot please all of the different voices that have told them what to believe. They are frequently left with questions about what they personally believe is right and wrong. In the crowd of other voices, they often struggle to hear their own and determine what they believe.
This conflict typically makes initial experiences with sexual touch confusing and overwhelming. If their brains are busy processing their emotional and cognitive thoughts about sexual touch, it doesn't leave much space for their brains to process the touch itself.
Atypical Sensory Introduction
In the unfortunate situation of childhood yeast infections, urinary tract infections, constipation problems, and/or sexual abuse, females develop sensory awareness in the pelvis that is negative and complicated.
Pain and itching associated with infections can establish negative sensory awareness in the pelvis at an early age. In the absence of any experiences with neutral sensory stimulus, the brain may begin to expect that sensation in the pelvic area is a bad thing.
In the event of constipation, children can have pain with pooping, which can also establish a negative internal sensory awareness in the pelvis. This can become a complicated and chronic issue that is self-perpetuating. Children who have pain with pooping often want to avoid pooping. This in turn leads to constipation, which produces further painful experiences with pooping. Children who develop what is formally called "stool hording" tendencies may require medical treatment by their physician or a pediatric pelvic floor therapist to help break the cycle.
For children who experience sexual abuse, developmentally inappropriate introduction of these types of sensations are often confusing and overwhelming. Recovery from this type of trauma typically requires intervention by a trained mental health professional to retrain the brain how to process those experiences in a healthy way.
Closing Thoughts:
When you stop to consider how sensory awareness in the pelvis develops, it is not surprising that many females don't develop good sensory awareness in their pelvis. This can happen even for people who have healthy and normative developmental experiences. Fortunately, if you have trouble with your bowel or bladder, if you have problems with pelvic pain or with sexual function, the nervous system can be trained. Cultivating pelvic sensory awareness in women can still be achieved in adulthood.
Working with a pelvic floor therapist can help address these issues. This article is intended for educational purposes to help you start a conversation with your doctor. It is not a replacement for individual medical advice. If you are interested in scheduling an evaluation with a pelvic floor therapist to discuss your unique case, click book here.
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