Vagina (14 page)

“Once I instruct them to resist,” Dr. Richmond said, of his sexually traumatized patients, “I can push with all of my strength and they will be solid as a rock.”

That astonished me: when a rape survivor is told to resist, her body reacts differently. “So that’s a mind-body thing.”

“Exactly—for what it is worth. I imagine my role as a physician and an authority ‘allows’ them to resist. The stability is there—once they have been ‘given permission’ to resist. These are the same patients who, without the instruction, fall over when pushed.”

To restate what Dr. Richmond is saying: rape victims are sometimes
literally
“destabilized” by the rape.

I wondered about the relationship of this information to the brain-vagina connection: Had trauma to the vagina also affected the brain, or was it an unrelated but just as intriguing imprint on the brain from sexual abuse?

“There is no doubt that when you have extreme levels of trauma, you can see that in the body. I don’t ask everybody about sexual abuse but when I see this pattern and ask about it, it is amazing how often I will find it. I say it is an interacting variable. They may have other things going on, but this question of sexual abuse needs to be incorporated into the treatment if you want an explanation for why these symptoms are happening to this person now. They have multiple layers of medical problems that accumulate over time, from obesity to migraines to mental health disorders.”

“Because of the sexual abuse?” I asked. “Yes,” he answered. “I get that you are saying we can’t say one thing is the cause. But it sounds like you are saying that the effect of sexual abuse on the female body should be a field of study.”

Dr. Richmond agreed. “Nobody fully understands ‘conversion disorders,’ ” he explained. “The term refers to a physical abnormality generated by a mental state.” The popular expression for conversion disorders is
hypochondria,
or the phrase “it’s all in your mind.” With a conversion disorder, someone suffers a real symptom, but the cause is not apparently physical. “Though there is nothing apparently ‘physically wrong’ with these patients,” said Dr. Richmond, “we need to take what is happening to these women seriously. Their symptoms may be caused by an abnormality in the brain generated by abnormal memory traces or abnormal neural circuitry.

“If you’ve been attacked by somebody repeatedly, you develop a whole behavioral motor response to that attack. You may later passively dissociate and feel, ‘Somebody’s doing something to someone’s body, but it is not my body.’ ” Dr. Richmond said that one’s learned response to that attack could be carried through life.

I told him about how I was looking at pelvic nerve mutilation in women who had been violently raped in Sierra Leone, and at the interruption in dopamine delivery to the brain that the injury involved. I explained that I wanted to understand if, and if so how, sexual assault to the vagina might have a physical effect on the female brain.

“I would argue,” he said, “that it is the brain that affects the body after trauma. You get direct nerve injury from vaginal assaults such as the ones in Sierra Leone, but it is the brain affecting the entire system after that, or apart from that gross trauma. In the West you can see these effects on women from sexual trauma of less obvious kinds. Behavior is a global response: if someone is traumatizing you, your visual system is affected, your auditory system is affected; these are all integrated, and your brain is continually learning new reactions from the trauma.”

I restated: “So it is accurate for me to say that if you traumatize a woman sexually, even if there is no ‘violence,’ you are physically traumatizing her brain.”

“Yes,” he repeated. “I think that is something that is fair to say.” He thought some more. “I had this one patient who had a history of sexual abuse in childhood. As an adult, she presented with an aversion to certain sounds: this is a condition called misophonia, a spontaneous emotional response to certain sounds. Imagine how you feel about fingers against a chalkboard; for people with this disorder, clicking or chewing or other sounds can become intolerably emotionally abrasive. The adult disorder may have some original link to early sexual abuse from her father. She remembers him in the corner, making these noises, and it was a linked memory to the abuse.”

I told him, in response to this, about the puzzle that had bothered me for so long about women’s recovery from rape—that so many women who had, through therapy, dealt intensively with the psychological effects of their rape, who had had good sexual responses before their rape, and were with safe, supportive, loving partners, simply could not enjoy sex again the way they had done before the rape.

“So,” I asked Dr. Richmond, “does this dysregulation of the autonomic nervous system after sexual trauma possibly help explain what I observed about rape survivors—that they may be having trouble with sexual arousal and pleasure after the assault in part because of actual physical changes to their autonomic nervous system, due to that trauma?”

“Can rape or sexual assault induce a permanent shift or change in the autonomic nervous system? Arguably it could; a growing literature confirms this. Some people’s systems may make them more vulnerable to this. It may be that some women are more resilient than others, some men more resilient than others, against PTSD, in terms of the question of possible damage to the autonomic nervous system from sexual trauma. But wherever your emphasis, it is clear that when people have extreme experiences outside the norm, those experiences will have an effect on vulnerable populations and will affect the autonomic nervous system.” Indeed, other recent studies confirm that women who have been raped or sexually abused, especially in childhood, show striking physically measurable brain differences from women who have not been raped through changes in the size and activation of the hippocampus, and differences in cortisol levels.
³

In other words, when you rape a woman (and perhaps also when you rape a man, though the data here are based on female victims), or if you sexually abuse her in childhood, you may be repatterning her body, possibly
for the rest of her life,
in ways that embed fear, more easily triggered stress responses, and attendant risk aversion, into the very neural fabric of her responses to the world, and that, as we will see, in the case of the changes in the hippocampus, may even interrupt her ability to process recent memory in a way that might strengthen her ongoing sense of self.

For at least one of Dr. Richmond’s patients, there was a vocal symptom related to sexual trauma. “I have a very interesting case,” he told me. “It appeared that this patient had episodes of ‘expressive aphasias’: for long periods of time, she had a complete inability to talk. She had suffered horrendous abuse before the age of two—when she was preverbal. This person’s physical behavioral response when she was an adult under stress was to regress to a preverbal state.”
⁴

A broad study has confirmed that many health problems, seemingly unrelated to the original rape, follow a sex crime: Roni Caryn Rabin, who wrote “Nearly 1 in 5 Women in U.S. Survey Say They Have Been Sexually Assaulted” in the
New York Times,
reports on the many health problems that can follow rape: The National Intimate Partner and Sexual Violence Survey supported by the National Institute of Justice and the Department of Defense, she wrote, looked at 16,507 adults. A third of women said they had been victims of a rape, beating, or stalking, or a combination of assaults.
Rape
was defined in this study as “completed forced penetration, forced penetration facilitated by drugs or alcohol, or attempted forced penetration.” By that definition, “1.3 million American women annually may be victims of rape or attempted rape.” (One in 71 men has been raped, according to the same study.) “A vast majority of women who said they had been victims of sexual violence, rape or stalking reported symptoms of post-traumatic stress disorder.”

Other surprising, and seemingly unrelated, health problems also correlated with the sexual assaults. The women who had been sexually assaulted had higher rates than the nonassaulted women did of asthma, diabetes, irritable bowel syndrome, headaches, chronic pain, sleep difficulties, limitations on mobility, and poor physical health in general, as well as higher rates of mental health problems. This link between sexual assault and other chronic health problems in other body systems seemingly unrelated to the assault, confirms findings in smaller studies reported by Lisa James, director of health for the nonprofit Futures Without Violence: her data, too, suggest that even a one-time act of sexual violence can chronically affect the victim with seemingly unrelated health issues.
⁵

So is all rape about sexual aggression or male neurosis? Or can the sustained cultural presence of rape also or even instead, at times, be about reprogramming women at a core physical level to be less brave, less secure, less robust in other ways, and to go through the rest of their lives, potentially, with a less stable sense of self?

I would soon speak with a Tantric guru named Mike Lousada, and an osteopath named Katrine Cakuls, read a book by an energy worker named Tami Lynn Kent,
⁶
and interview my own gynecologist, Dr. Coady; all of them would describe a constriction in the musculature of the vagina as a response to trauma as well. Dr. Coady would identify it as vaginismus; Lousada would describe “knots” in the vaginal musculature of rape survivors; Kent would note that muscle constriction in the vagina can cause other kinds of imbalances in the rest of the body; and would describe as constricted the vaginas of women who believe they are “uptight” emotionally—women who often turn out to have had sexual shaming, or worse experiences, in their pasts.

Katrine Cakuls is a highly trained Manhattan cranial osteopath at Cranial Osteopathic Approach, who heals women by, among other treatments, doing internal nonsexual vaginal work. She is also sure that emotion affects women’s vaginal sensitivity and muscle tone and can even exacerbate vaginal and other kinds of pathology. She, too, believes from her experience in her own practice, that when she “frees” tensions in the vagina, she can free other emotional issues in the female mind that may have gotten stuck, releasing areas of a woman’s creativity and sexual health that had been suffering from low vitality. Tami Lynn Kent, author of the cult bestseller
Wild Feminine: Finding Power, Spirit & Joy in the Female Body,
is a body worker who does nonsexual vaginal massage. She has a national following of body workers who hold similar beliefs and who work on the same area. Her view is that different quadrants of the vagina hold different kinds of blocked emotion, and that these can be released through internal manipulaion.

I interviewed the clients of body workers who specialized in nonsexual vaginal massage, or osteopathic adjustment, and many of them said that the intimate and unconventional treatment had effected remarkable emotional healings. All this, of course, would until recently have been considered fringe in the formal medical establishment. But medicine and science are in some places catching up with the anecdotal evidence of the cranial osteopaths and body workers. Researchers Yoon et al., as we will see, have recently found that stress and trauma actually do affect the very functioning of the vagina.

I remarked to Dr. Richmond, “It seems that women who present with symptoms that may result from sexual abuse are dismissed by medical professionals as hysterical if there is no physical cause—or else pathologized as nuts by psychiatrists.”

“Many women would say that,” he responded. “Women do not want to hear from doctors that ‘it is all in their head’ and, by the same token, many are scared of going to psychiatrists because they fear being labeled crazy due to their symptoms, when they know they are not crazy.

“As the growing field of neuropsychoimmunology shows, the mind-body connection is very real. Science is now developing tools to objectively demonstrate these changes, and reflect our greater understanding of the complex responses between brain and body: the functional ways in which memory is laid down and physical responses follow.

“It is easy for me to say, ‘It is all in your head,’ ” he concluded. “That is, everything neurological is real, and it can also be all in your head.”

What Dr. Richmond was seeing anecdotally has been documented in recent studies. There is growing, if still preliminary, evidence that rape and early sexual trauma can indeed “stay in the body”—even stay in the vagina—and change the body on the most intimate, systemic level. Recovery is possible, but treatment should be specialized. Rape and early sex abuse can indeed permanently change the working of the sympathetic nervous system (SNS)—so crucial for female arousal; and, if she is not supported by the right treatment, it can permanently alter the way a woman breathes, the rate of her heart, her blood pressure, and her startle reaction, in a manner that is not under any conscious control.

At least one major 2006 study confirms that the trauma of a history of sexual abuse not only can dysregulate the SNS—creating, as Dr. Richmond saw, a permanent higher “baseline” SNS activation in sexually traumatized women—but also can lead the vagina to respond differently—less effectively, with less engorgement—to exercise, and even to the subjects’ viewing of erotic material.

Researchers Alessandra Rellini and Cindy Meston, when both were in the psychology department at the University of Texas, confirmed that sexual trauma in childhood really can affect and damage not just the psychology but the physiology of the vagina—and of female sexual arousal—years after the trauma took place.
⁷
They checked the cortisol levels from the women’s saliva, heightened their SNS reactions through exercise, and then showed them erotic videos. They measured the women’s “vaginal pulse”—the ease of their vaginal engorgement—via the strength of the blood’s beating through that area.