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The chairs are white molded plastic; the walls, also white, are blazed with a quotation in elegant script. Driftwood has been strung over the stairs which lead down to the lower level, a sad dead mobile that sways every time the glass-paneled front door opens. I’m touching Dani, holding his hand, trying not to feel and yet feeling anyway: fear, mostly, but also hope. The bathroom is down the hall to the left, the receptionist tells me. I use it. Come out again, sit down. We’re facing the doctor’s office. It’s nicer, all of this, than the public clinic I’ve been going to in south-central Madrid. After three months of appointments—five visits with my general doctor, a testing center, an OB-GYN—maybe this is the specialist who can help me.
Doctor López opens the door to her office. She’s wearing a white lab coat and a broad, pleasant smile which won’t falter once during the entire 90-minute consultation. She calls me Clare in the same way that most Spaniards do: Cla-ray.
“Elena,” I interject. “Preferiría que me llamaras Elena.”
The doctor takes me in, the very blonde American girl with the second, more pronounceable name.
“Quieres que entre contigo?” Dani asks. Do you want me to go in with you?
He’s still in his work clothes, sweat darkening his button-up on this already hot June day. He’s cut his hair too short again; it’s always a surprise, how severe he can look, the white scar a taut parenthesis off the left edge of his lip. He has pale blue eyes, a few gray hairs. I love him, which is its own complication.
“Yes,” I say, tightening my fingers in his hand. “Come with me.”
The real trouble, though I didn’t know it then, had begun three months earlier, in April, on the island of Tenerife. It was Semana Santa, the Holy Week before Easter, and all Spaniards—the religious, agnostic and atheists alike—were on a nationally designated spring break. Spain, for the week, was closed. Dani and I, after some discussion, had decided to travel to the Canary Islands, a small archipelago sixty-two miles west of Morocco and Spain’s southernmost autonomous community. There was beach, yes; blue waters; rows of fresh caught marine bodies gleaming from aisles in the supermarket, awaiting a bit of heat and then our plates—but more than that, there was sport, and first, of course, there was Mount Teide.
Barely 24-hours after landing on Tenerife, I found myself rubbing sleep from my eyes as Dani shrugged into his fleece. Above the surrounding ridges of volcanic rock, Mount Teide rose into the sky like a multi-colored dome. I stared up at it as I shouldered my day pack. High along Mount Teide’s round flank I could make out two metal towers, the drop-off for the cable car and the access point by which a daily 200 visitors would gain the summit by hiking just 200 feet. Given the aggressive saw of the mountains we’d seen and hiked in the Pyrenees, the Sierra Nevadas, the Picos de Europa, it was hard to believe that this gentle form, marooned out here in the Atlantic, was, at 12,198 feet, the tallest mountain in Spain. Especially given that it wasn’t even a mountain.
Mount Teide had last erupted in 1909—not a full-on summit eruption but enough to send blocks of rock shooting nearly 500 feet into the air, a glowing column of light and smoke visible from the neighboring island of Gran Canaria more than 60 miles away. Scientists, I learned, had an “optimistic outlook” on the volcano—she’s got Vesuvius potential but a low probability of blowing her top, with eruptions occurring just once every 4 to 6 millennia.
We snaked our way across the caldera, laughing at the aptly named los huevos del Teide, the accretionary lava balls hurtled out by the volcano, some standing easily 10 feet tall. It was a moderate day hike: 12-miles round-trip with an elevation gain of 5,000 feet to the summit. But maybe it was the thin air or yesterday’s 5AM flight—but I felt bad, tired, and it only got worse when the trail climbed, dogged off into switchbacks. I kept trying to pull my head up, to look around. I could see the ocean, the clouds rushing in to meet the island, the green procession of trees just beyond the crater. The ground underfoot was scorched: black volcanic rock flowing into red volcanic rock flowing into yellow flowing into white. Trails of smoke slid from the mouths of small rifts, fumaroles expelling blasts of sulfur near the summit. I put my palms to the tops of my rising thighs, using my own energy like an engine to push myself forward.
“Estás bien?” Dani asked as I stopped, again, for water.
I waved him off as I recapped the bottle. We’d spent the last eight months testing our limits together—pounding up Madrid’s Paseo de la Castellana in a surge of runners on race day; meeting up with friends to rock climb in Cuenca and Ávila and Patones; driving into the Guadarrama Forest where we lashed crampons to our boots, fit our hands to ice axes. This was barely our second day on the island, this hike a mild one at that.
“Just feeling the elevation a bit,” I replied as I adjusted the straps on my pack. How could I be anything but fine? I loved this after all—we loved this: outside, the strain of our bodies, the deep flush of air through our lungs. It’s what had brought us together; it’s what we did.
Though I didn’t know it then, slowly working my way up to the summit, this was all part of the tipping—not, by any means, the sole cause of my impending medical problems, but the last in a long series, the proverbial straw to my camel’s back. In less than two weeks, we summitted Mount Teide, hiked down to the Cliffs of the Giants, rock climbed 360 feet up the Cathedral Spire and, returning to Madrid, ran a half-marathon with no prior training. I didn’t know it then: not as we ate papas arrugadas and drank the traditional honey rum, not as the Easter procesiones toiled past us in Santa Cruz de Tenerife, the shuffling of so many churchmen beneath the elaborate float of the crucifixion, the young barefoot man heaving the cross and the way he collapsed, hours in, his shackled legs stumbling beneath the heavy, dark-painted wood.
What I did know was that I was tired: so tired that when Dani came to bed that night, his arm, his warm, settling body, hurt me where we touched. He pulled close in the cool, rented room, his dry mouth brushing my neck, his legs curling into mine. I was beyond exhaustion, my face burned pink by the wind at the summit of the volcano, my body brought to a place where any interaction seemed, lying there in the island dark, like an unbearable touch.
Doctor López has short red-brown hair, a youngish looking face and form. After the physical exam, she begins to tell me gleefully—there’s really no other word for it – about my chronic condition. It’s possibly the most absurd part of the entire horrible afternoon: not the uncomfortable pre-exam questions, not the invasive exam itself; no, it’s this woman with her full set of chemically-whitened, smiling teeth. This doctor who is happy, somehow, to tell me that my days as an athlete are possibly over—that they will be for the next few months certainly and could be forever. I try to focus on the relief of finally having a diagnosis. No more dismissive gynecologists, no more cervical cancer tests. I have:
“A hypertonic pelvic floor,” Doctor López tells me through a big, shining grin. Also commonly known as a nonrelaxing pelvic floor, I have one of the frequently misdiagnosed disorders which are gathered under the umbrella term “pelvic floor dysfunction.”
Doctor López has a model which she gamely begins to pull apart: the orange bladder, pink uterus and gray rectum popped out of the clear pelvis and onto her desk. The pelvic floor is red, a hammock of muscles, ligaments, connective tissues and nerves which support these organs as well as the spine. My problem—her cheeks twitch joyously—is that my pelvic floor muscles have involuntarily contracted into their tightest position and won’t relax. This constant contraction—I imagine a tightly balled fist in the cradle between my hip bones—can keep the pelvic floor muscles from properly serving some of their most basic functions. Functions like going to the bathroom. Functions which require precise coordination between muscle groups and, most importantly, muscle relaxation. And that’s not all. A hypertonic pelvic floor—I visualize, again, that fist—can also provoke extreme discomfort during sex and a “pelvic ache” afterwards; the nonrelaxing muscles can cause pain to radiate out to the groin, lower back and thighs; that fist lodged in my lower body can hurt secretly on any day, at anytime, anywhere.
I almost let out a horrified laugh, but don’t. It’s like I’ve been walking around for three months in a state of constant Kegeling, my pelvic floor caught in an unceasing, unflinching, unrelenting crush. I almost—almost—feel lucky. My symptoms—the constant need to pee, a heaviness in my vagina as though every day is a bad period day, the inability to use a tampon, the impossibility of having sex—while not unbad, are not, Doctor López wants to cheerily inform me, the possible worst.
Dani leans forward, asking more questions, simplifying the doctor’s Spanish whenever I’m unable to follow her excited, short-breathed onslaught. He’s not nervous; he’s not ashamed for me. An aerospace engineer, he likes the mechanics of machines, the physiology of bodies. I am sunk back into my chair, overwhelmed; the doctor talks as though I’m not there.
“She’s just done too much,” Doctor López tells Dani. “It’s notoriously difficult to pinpoint the exact cause of a hypertonic pelvic floor but given what she said I would guess there’s some postural abnormalities coupled with too much stress.” She’s wearing lipstick, a matte pink, “Climbing and running focus a lot of pressure on the pelvic floor.” Here, she turns to me: “Your body just isn’t meant for these kinds of impact sports. Me entiendes?”
I look at Dani to see if he has heard the same thing I have, but he is already asking another question. I blink around at the room, stunned, wondering what she could possibly mean. I think about baseball practice when I was nine, how excited I had been, played at third base because of my good arm, lined up third to bat because of my good legs. I think about volleyball in middle school, the snapping formation we reshaped with our bodies; how the high school soccer coach positioned me at sweeper, the last line of defense before our goalie, because of my aggressive, slamming style of play. I think about running the steeple chase in college, the hitch of my legs over the normal hurdles before the splash and cold of the water hurdle, my spikes digging for purchase into the slick skin of the track.
I think about this past year with Dani. About that first night in September almost ten months ago now, how I’d shamelessly chased him down the sidewalk to ask for his number. We were both climbers in need of a climbing partner. It had been the most straightforward thing in the world.
“Elena, escúchame,” Doctor López’s mouth is saying to me. “You are going to have to stop. No running, no climbing, no biking.” She pauses to consider, then, “And no yoga either.”
It seems impossible, but she continues: no crossing my legs, no sitting with my knees pointed too far out, no holding it in when I have to pee, no abdominal exercises of any kind. When possible, I should seek to prostrate myself on the ground at least once during the work day for as long as I can manage. At home I am to lie on my back with my feet propped up against the wall, thus relieving any potential strain on my pelvic floor. Swimming in moderation is allowed, just not the breast stroke. She smiles and smiles and smiles, her tongue working away endlessly in the cavity of her mouth.
At the end of the consultation, the receptionist charges me 120 euros and arranges for my first weekly physical therapy session. The meter on Dani’s parking spot has run up and so we move quickly, not speaking, the day outside gloriously bright in barrio Malasaña.
Doctor López wouldn’t give me a straightforward timeline, no X many weeks until you’re all better. No date to circle on the calendar, no reassurance that my health and my life would, eventually, return to normal. I look at Dani as he maneuvers the car out into the narrow street. I can see that he’s tired; he’s in the final hiring stages for a position at Airbus and it’s been a tense, drawn-out process. Just a week before this, we had a fight—our first really, in all these months—and it was that kind of argument that I’d heard fellow expats laugh about: big, public and Spanishly dramatic. I’d stood there on the sidewalk, sobbing and snarling, unused to his anger, my anger, the whole confused hurt of it all.
“If it’s between sex and sports for the rest of my life,” I try to joke, “I think I know which one I’ll choose.”
But Dani doesn’t say anything as he downshifts, doesn’t look at me. I am struck again by the seriousness that a short haircut reveals in his face; by the realization that parts of him are still unknown to me, that there may always be—despite months of openness, closeness, tenderness—some of him that is unknowable. That if asked, he would probably say the same thing about me. In the silence, I turn to look out the window.
What does it mean—I think as the streets unspool around us—when you can no longer have sex with your partner? And what could the doctor possibly mean when she said that my body wasn’t made for sports, for the things I’ve always done and will always, always want to do?
Zosia Mamet moves from the armchair to the podium, then back across the stage. She looks composed, exasperated, angry. I hold my phone down low in my lap, tightening the plug of my earphones in my ears as the light rail shoots me out to the school where I teach in western Madrid. It’s my first week post-diagnosis and I’ve decided to do some research. Zosia, an actor who rose to fame as Shoshanna on Girls, a Google search for “pelvic floor dysfunction” informs me, is a fellow sufferer. Speaking to a full conference hall, she recounts the story of her 6-year struggle for a diagnosis and the litany of doctors who, unable to relieve her chronic symptoms—“insane urinary frequency, unbearable pain during sex and a vagina that felt like someone had stuck a hot poker up it”—tried to convince her that her pain wasn’t real.
“Perhaps the pain is just emotional,” offers the Best Gyno on the East Side.
“I know your type,” intones the Best Urologist in the Nation. “You’re an uppity actress and you need to learn to self-soothe, Missy.”
But Zosia’s pain isn’t imaginary, and she doesn’t stop looking for an answer. She’s prescribed high-powered, disorienting pain killers by one expert, while another pours acid into her vagina, burning away the “infected” tissue so that “healthy” tissue can grow back. As the test results continue to come back negative—no UTI, no yeast infection, no bacterial infection at all—she’s told over and over again that maybe the problem is her. Zosia stares out into the darkened room, her gaze hard.
“Female hysteria,” she says coldly, “is still a very real medical diagnosis.”
I click on another link, an article which someone at the Irish Examiner, thinking themselves clever, has titled “Floored by Condition.” Emily Rose O’Donovan, I read, is just 11-years-old when she begins to experience the typical symptoms of a hypertonic pelvic floor. Her medical community, flummoxed, gives her antibiotics, sleeping pills and strong antidepressants, which send Emily Rose into borderline psychotic episodes. Over the next ten years, they will dilate her urethra, insert a laparoscopy camera through her belly button and electrocute her vagina. After another failed attempt, Emily Rose says, “I woke up from surgery, looked down at my pants. It looked like an alien had exploded there.”
When none of these treatments work, Emily Rose is told that she is the problem. She is “troublesome,” gets too “worked up” and needs to “relax.” Now a late teen, one doctor prescribes her Fifty Shades of Grey and a vibrator. Another says: This pain will just be in your life now.
It takes 10 years, and a trip across the Atlantic from Ireland to Minnesota’s Mayo Clinic, before Emily Rose is properly diagnosed. A hypertonic pelvic floor. The treatment? Simple physical therapy, just the same as Zosia is eventually prescribed. Just like me.
I navigate back to the initial search page, to all the stories represented in light-up-blue links.
After returning from Tenerife, it had taken two months of appointments with my general doctor and a series of tests at a lab in southern Madrid before I was finally given a referral to see a gynecologist. It was a big public building off the Puerta de Toledo roundabout: each catacomb-like floor housing different medical specialists. I’d looked at the thick net strung elaborately in the channel of open space between the ascending white marble staircases, seeing an art installation. Dani saw suicide prevention.
The gynecologist had spent all of 10 minutes with me. Purple latex glove. Pants and underwear off. She spoke to me in Spanish as though I was very, very slow. From behind her desk she told me, “There’s nothing wrong with you. Everything is fine, me entiendes? Estás perfecta. Perfecta.”
I’d stared at her, too shocked to be angry—although that came later, yes, the shred-with-your-hands type of anger—and so dismissed by the medical expert I’d been counting on to help me, I left.
The day after my gynecologist appointment, I stared at the pixelated image of Katherine on my computer screen and said, “I’m having this kind of weird problem.” Katherine, as usual, was sitting in an empty classroom in an academic building. We’d become friends as college freshmen six years ago, runners on the cross-country team. Now, she was studying both her MD and MPH in Pennsylvania. We kept in touch sporadically, skyping every few months across the 6-hour time difference. I trusted her, trusted that, at the very least, she would hear me.
“That sounds muscular,” Katherine said, listening closely. “Like something with your pelvic floor.”
By the time the light rail delivers me to my stop, I’ve read enough to know that something is incredibly wrong. After Tenerife it took me three months to put a name to my symptoms—which, I recognize gratefully, are not nearly as severe as those experienced by some women—but only, only because of Katherine. Without her, how long would I have cycled between doctors’ offices before receiving an accurate diagnosis? How can it be possible that some women have to spend agonizing months and years seeking proper treatment? How can huge swathes of the medical community still deny what’s happening to our bodies?
After school that day, I continue reading. Dr. Isa Herrera, a Master of Science in Physical Therapy and a specialist in pelvic floor dysfunction, asserts on her website that despite “affecting close to 30 million women across the United State . . . the average woman sees 6 or 8 doctors before they get a diagnosis.” She calls it the “doctor roadshow.”
I scroll through more websites, link to new pages. Dr. Jen Gunter, a San Francisco-based gynecologist, informs me that while pelvic floor dysfunctions are common for women, and even affect some men, many doctors are still unaware that these conditions exists or, worse, don’t believe they’re real conditions at all. A whole network of stories pulse across the internet: women like Zosia and Emily Rose and, well, me, who’ve been dismissed and ignored. I click on a video titled “Pelvic Floor Release Stretches” on FemFusion Fitness, the YouTube channel of pelvic pain specialist Dr. Brianne Grogan.
“Thank you so much for making this video,” Catherine F. posts in the comments. “You’ve given me hope for restoring ease in my body.”
Further down, Mooner Muhammad writes, “I love you so much dear . . . [I] had lost hope for my pain.”
I lower myself into the water. It’s a warm Saturday at the end of June, late afternoon, and the pool has at last emptied of the 20 or so wriggling, thrashing, raucous young bodies that are always frothing the waters during the hours of peak heat. I’m three weeks post-diagnosis, a week into physical therapy. Nearby, two old men are playing cards at a plastic table, a group of middle-aged women lounging half-in and half-out of the water, their legs stirring in slow motion. I turn. Behind me, Dani is making a face as the cold spray of the mandatory rinsing shower strikes his neck and back. I wet my goggles before sliding them over my face, pinching the suction-y rubber tight at the nose. The sun in Madrid is always beating, even underwater where the small white tiles are now glowing. I slide off into free style: three strokes, breathe left, three strokes, breathe right, three strokes, then a few more, then a drop of my right arm, a curve down of my head, my whole body following me into the flip turn, the solid plant of my feet against the side of the pool before I’m pushing off, kick, kick, kick.
I was never the strongest swimmer during those cool morning practices. I remember the milling of six of us in a lane, the drills, our child bodies shooting or tipping or crashing into the pool from the starting blocks, the water-gulp fear of drowning. I remember watching our dive instructor that winter at the indoor diving well, his lithe body dangling from the dive platform by just his flexed feet, a bat hang before he seared into the water. I remember standing on the tallest platform, an eight-year-old with blonde hair greened by so much chlorine, inspecting the 33-foot drop to the water, deciding it was best not to think too much before I stepped off, my body formed straight and pointy like a pencil, like they were always telling us to do.
I was never the best swimmer, the best diver. What I was good at was sharks and minnows, was holding my breath, skimming the bottom of the pool, the glugging noise mounting in my throat as I held down the panic, 30 meters, 40 meters, once, I swear, the entire length of the pool on just one breath. Bursting through the surface, all mouth and lungs and air.
I twirl around Dani’s underwater legs, tugging at his trunks before emerging in front of him with a grin. His skin is already browning, his fine hair plastered over his forehead. He’s laughing, tossing water at me with cupped hands. I drop into a handstand, my legs shot out into the air, waggling at him, before he pushes me over. He got the job at Airbus; the school year ends in one week, bringing with it my summer vacation. Next Saturday we’re headed to Berlin. We know, at last, what’s wrong with me, going together to my first session of physical therapy earlier in the week.
Later that night, after dinner, after drinking tinto de verano—the preferred summer drink in Spain, lemon Fanta and red wine—we go into Dani’s bedroom. I’m awkward, uncomfortable. I wish I could make the feeling go away, cannonball the bed like normal, Dani half-yelling and half-laughing as he rolls away just in the nick of time. I wish I could dance around in my underwear, demanding a striptease from him before he throws his socks at me, joins me in a chaotic shimmy around the room.
Instead, I lie down on the bed, feet flat and knees up. Dani is dimming the lights, putting on soft music, lighting specially purchased candles.
“Tienes que relajarte,” he says, to which I respond with a nervous snort.
He starts just as the nurse instructed during my physical therapy, his hands brushing down the insides of my thighs, touching me in the same soft places where he has touched me before, but now, of course, for different reasons. It’s less scary than I’d imagined: this is Dani, after all. He knows my body—not just my bedtime body but my working body, my climbing body, my sweating, fighting, determined body—better than any other person alive. I close my eyes, focus on the long belly breathes I’m supposed to be taking. Dani’s fingers push gently back against my internal pelvic floor muscles, a slow process of coaxing relaxation.
I’ve hardly been able to admit it to myself, the worry that I’ve felt like a dry hum since it became apparent that there was no “quick fix” for me. But it’s there, embedded as deep as this balled fist in my pelvis. When will he get tired of this? Of physical therapy, of missed climbing and mountaineering trips, of no sex? How long will it take for him to fall out of love, his partner suddenly incapable of doing the things that brought them together—that together we’ve always done?
The next day, I call my friend and former climbing partner Pioli. I’ve been emailing her little medical updates and waking up this morning, I feel the need for a full check-in. To hear her voice, however far away.
“He does what?” She barks over the phone, not unexpectedly. Thousands of miles from her, I reflexively cover my eyes with my hand, although, somehow, I find I’m not particularly ashamed.
“He came to my first physical therapy appointment,” I explain. “And the nurse asked if he wanted to help me do therapy at home to speed up the recovery process. And he said yes. And so she . . . showed him what to do.”
There’s a short silence on the line, then, “Vagina massages. Vagina massages.” And we’re both laughing at the same time, this thing that seemed horrifying becoming, not unawkward but funny, another absurd part of being alive. I imagine Pioli in her kitchen in Salt Lake, her big dogs Bodhi and Ranger laying at her feet, an apron around her waist, her arms bronzed and muscled as they emerge from the cut-off sleeves of her t-shirt. I imagine the chickens rooting around in the backyard, the messy rows of her garden, the small roofline just visible over the back gate, a friend’s tiny house parked at the tail end of the lot.
We start to make jokes about Dani’s finger strength—a constant preoccupation for climbers—and by the end, Pioli has settled into calling him “Doctor Dani.”
“It’s funny,” I say right before we hang up. “It made things feel different between us. Like most partners don’t have this kind of deep . . . I guess I’d say familiarity? Intimacy? Until they’re having a kid.”
At Dani’s that night, I listen to his soft sleep sounds, the little high-throat protests as I move against him, fitting my body to his. Estamos cucharando, I always tell him. We’re spooning, which isn’t real Spanish, where “spooning” is relegated, as far as I’ve been able to determine, to the lesser “abrazando,” hugging. He’s a good language teacher, stifling laughter when I shout out farlopa instead of forro polar—me asking him if he’s got my cocaine instead of my fleece pullover. I’ve engaged in a few devious acts myself: Dani knows “stomach” exclusively as “tumbly wumbly” and bagels as Beagles and Beagles as bagels. It’s a cross-language love, a despite-language love, which even in my head sounds stupid, even though that’s exactly what it is.
The first thing we ever did together was climb. I watched him flake the rope, clip quick-draws to his harness. I was buzzing: not two weeks after moving to Madrid and here I was, climbing, when I’d all but resigned myself—after years of working in remote locations for the Forest Service, after living in mountain-ringed Salt Lake and notoriously “outdoorsy” Portland—to the limitations of big city life. Dani climbed slow, thoughtful, static flowing upwards. He explained, patiently, the proper terms: pilla for “take,” chapas for “bolts,” reunión for “anchors.” It didn’t bother him when I pulled a move that he couldn’t. He listened to me as I garbled words, shooting out half-sentences in Spanish. He was kind.
I trace the unfinished tattoo which spills over his right shoulder blade. I don’t like it, but that has long since ceased to matter. I realize now that we really are going to be okay. There’s partnership even when there isn’t sex, there’s playfulness and laughter and joy. I think about what Emily Rose called our condition, a “metal detector” for finding good partners. I realize what I should have known weeks ago: Dani isn’t going to leave me because of this.
Weeks pass, then months, until it’s nearing winter again. I do the normal things: walk to the supermarket for groceries, prepare my classes, take the metro to physical therapy appointments. My symptoms are frustratingly fickle: much better one week, worse the next. The timeline for my recovery, four months out, is not much clearer, my irritation with Doctor López increasing weekly. I think of those smiling teeth. It matters to me that I can’t climb, can’t run, that she’s so blithe in dismissing my questions, so quick in erecting prohibitions. I carry around my secret fist, reminded daily of its existence, this heavy little anchor. I don’t hurt much, although I’m frequently running to the bathroom between class breaks. My general doctor has prescribed me a tube full of multi-colored paper strips: my own testing kit so I can check at home if I’ve got a UTI or if it’s my hypertonic pelvic floor.
A new roommate, Erin, moves into my apartment in November. She worked as a nurse back in the United States, and after one of many conversations about the #MeToo movement, she sends me an article titled “The Female Price of Male Pleasure.” I read it walking to Dani’s—Madrid can still be lovely, even in the winter—and it provides some numbers to what I already know. PubMed, a free search engine which allows users to access a database of medical abstracts, shows almost five times as many articles on erectile dysfunction—male pleasure—as it does on dyspareunia, vaginismus and vulvodynia—conditions which cause sex to be intensely painful for women. I open a new window on my phone, type in “pubmed.” A search for “hypertonic pelvic floor” brings up 16 items.
“Pelvic floor dysfunction” returns 4,355 items.
Erectile dysfunction? 23,695.
“That many women have stories of medical practitioners dismissing, misdiagnosing, or cluelessly shrugging at their pain is, unfortunately, nothing new,” writes Ashley Fetters in an article about health-care gaslighting for The Atlantic. She continues, “Research cited in the Journal of Law, Medicine & Ethics in 2001, for example, indicated that women get prescribed less pain medication than men after identical procedures (controlling for body size), are less likely to be admitted to hospitals and receive stress tests when they complain of chest pain, and are significantly more likely than men to be “undertreated” for pain by doctors.”
This information, while confirming, doesn’t feel surprising exactly. The question is, what do I do with it?
The answer, when it comes, isn’t consciously arrived at. I’ve been reading the stories of women online for the past few months. It makes sense. The first step, of course, is just to talk. To not be ashamed. To tell people. I take the secret away and I’m left with just a thing that’s happening to my body. A thing that’s painful, yes, but also surprisingly common. A thing which, I know, can be handled better, diagnosed earlier, recognized and treated before any more women are subject to acid baths or electrocuted vaginas or years and years of unsolved pain.
In Spanish, verbs are conjugated in a specific way to signify a command, an obligation. This conjugation makes the intent unmistakable, it knocks out fuzzy lines. It speaks for itself.
Hable, I demand of myself.
I’m alone in the small white room save for the box of tissues and the large machine set atop a rolling cart, cables protruding from an array of orifices. I don’t want to be here almost as much as I do. It’s 8 months since my diagnosis, four months since I found a different pelvic floor specialist. Tired of inconsistent treatment plans, of an ever-changing cast of nurses who couldn’t answer my questions, of spending almost a quarter of my salary on appointments, I’ve left Doctor López for Paloma. She’s striking, Paloma, in her black parachute pants and dark lipstick, her hair a long curtain which she is ever shrugging behind her shoulder.
“Soy muy perra,” she tells me as she turns her fingers up against the roof of my vagina, pressing them hard into the web of nerves. I’m a real bitch, she says as she adjusts the double line of acupuncture needles tracked down my lower abdomen, as she burrows her hands deep into the soft stomach flesh beneath my hip bones.
I cross my hands over my belly, half-naked and waiting in the empty room. I like to think that my grittiness as an athlete is due to my ability to tolerate pain, a bearing-up I’ve inherited from my marathon-runner mom. But I hate these days, these afternoons, almost as much as I look forward to them: with Paloma, I am getting better. She has given me daily stretches and targeted exercises to strengthen the muscles running up the interior of my legs. She has told me to return to climbing, to try it anyway, that if it doesn’t hurt than it’s okay to start again. It was probably the running—she thinks, from the women she sees—that it was probably the running, a pounding configuration of my posture and gait, that triggered this in me.
And she’s right. After eight months of not climbing – after eight months fearing I would never be able to do one my favorite things ever again—I return to climbing and find that I am okay. I am, carefully at first, then more boldly, just fine.
I fidget, rearranging the paper skirt on my thighs. It’s hard to know exactly how to feel when what’s healing me also really goddamn hurts. Treatment consists of heat therapy, external and internal deep tissue massages, occasional acupuncture and a variety of dilators, the worst of which can be pumped up inside me like a balloon.
Paloma comes bustling into the room with her usual explosion of sound, her Hola guapa-s, her Qué tal mi amor-s, her How are you doing honey-s. She smells faintly of the cigarette she smoked on her lunch break as she interrogates my health: Any pain since our last appointment? How was climbing this weekend? Sex? She has a forceful presence, hard almost, wrinkles beginning around her broad mouth. Last week she showed me photos of her teenage son, her daughter, the three of them on the shore with surfboards tethered to their ankles. Paloma fusses over me, laying a blanket over my chest. She’s very physical, which I think I would say even if she wasn’t my therapist. Something about her wants to touch, wants to be touched. I can’t help but like her, this exhausted, beautiful, talkative person, even when she causes me pain, even now.
“You’re doing so, so well,” Paloma tells me.
I breathe deep, taking air into my lungs, letting it fill up my stomach—I imagine pushing the air all the way down to my pelvic floor, my entire body flushed with breath, then relaxed. Not the three-stroke pattern of swimming exactly, but another kind of oxygen certainty, of steadiness, of comfort. Over the last year, I’ve been at times embarrassed, afraid, in pain and incredibly vulnerable. Yet, none of these compare to that initial drowning in Dr. López’s office: to that exuberant mouth saying No, saying You cannot be trusted with your own body.
Paloma tells me something different. She looks at me with hard eyes and says, Yes, in time, you will go running. Yes, go climb. Yes, go.
I listen as she tells me in ways both big and small: “Elena, you don’t need to be afraid of your body.”
It is April again, Semana Santa, the Holy Week. A year has passed since Tenerife; it’s been ten months since I was initially diagnosed. Dani and I catch a late flight to Athens, rent a car from the airport and drive four hours north through a cool rain. Once we’ve passed beyond the illumined outskirts of Athens—the lit-up billboards, the curls of bright neon—we see nothing of Greece beyond the curve of the road, the dense clusters of fir and pine trees. We enter the small town of Meteora in the dark and the wet, eat tomatoes and Feta while sitting on the hotel bed together, wake up to long arms of obscuring mist. Around midday, the sun burns through the fog, reveals what Meteora—its name meaning “lofty,” “elevated,” “meteor-like”—is most known for. Six Eastern Orthodox monasteries perch high on immense pillars of sandstone and conglomerate rock, precarious man-made structures atop precarious earth-made ones.
In the 9th century, the first hermit monks claimed the pillars of Meteora as home: determined souls installing themselves on the tops of sheer rock spires, climbing fissures until they reached heights as great as 1,800 feet. In the 14th century, the hermits finally built monasteries, elevated gathering places where the monks could withstand Turkish assaults, could pull up their ladders and windlass and deny access to all who could not climb. Today, only six of the original twenty-four monasteries remain, with less than 60 men and women claiming these perches as their own. Today, they have cut steps into the rock, rendered climbing unnecessary.
Dani and I stand at the base of Dhoupiani, the rock pillar where, hundreds of years ago, hermits once congregated to say their Sunday prayers. We want to climb Isidora and Ostria, two entry-level routes for climbers still accustoming themselves to Meteora’s particular rock type. But Dhoupiani is damp in places, the rock slick and dark in others—we’ll have to wait. Instead of climbing, we take the trail to Drakospilia, the “Dragon’s Cave” beneath one of the remaining monasteries. We watch, applauding their slow, tireless determination, as two large turtles push themselves through the underbrush, a thunderous tumult of crashing and snapping. We pull ourselves into the cave, a cavernous space strewn with massive, exactingly geometrical boulders. We sit, looking up at the bolts local climbers have drilled into the walls around us, difficult routes that stretch out onto the ceiling above us.
I don’t know it then. I don’t know that we’ll climb Dhoupiani successfully the next day, or that back in Athens, on a rainy afternoon just like this one, we’ll have sex like we did before – pitched sideways across the bed, the sheets and blankets and pillows re-constellated around us.
I do know, from the bad English translation on the Meteora visitors’ guide, the legend of the Dragon’s Cave, and I tell it then to Dani as best I can. He listens, nudging my Spanish along when I falter, his eyes cast back to take in the vaulted ceiling, turned down towards the unforgivingly edged boulders, taking me in with his soft, clear gaze.
I tell him about the villagers of nearby Kastraki, how they came to Varlaam Monastery, terrorized, to plead with the monks for help. A dragon was slithering out of this very cave—I tap the block we’re sitting on—to hunt and slaughter and destroy them. One of the monks, so moved by the villagers’ desperation, cursed the dragon before—I pause for dramatic effect—jumping from the spire that Varlaam Monastery was built on. His sacrifice, his body exploding on the ground hundreds of feet below, caused the ceiling of this cave to collapse—I gesture to the large hewn blocks of stone surrounding us—and kill the dragon.
We let the silence sit around us, a shiver of light slipping into the cave to illuminate the rock. I can feel it happening then, have felt it happening gradually over the last few months as my symptoms have gotten markedly better – fear dissolving out of my body. I watch the sun spark off the metal bolts of a ferociously difficult route near the mouth of the cave. My body is at last beginning to feel fully mine again.
Clare Boerigter is a nonfiction writer who currently lives in Minneapolis. She has published personal essays about her experiences as a wildland firefighter for the Forest Service, including “Tender: The Ansel Bryson Adventure Cookbook” in JuxtaProse, “The Peaks” in The Siren and “The Fire Rises,” which won First Finalist in Vela‘s nonfiction contest and was featured on the popular firefighting website Wildfire Today. She tweets @BoerigterClare.