According to the Mayo Clinic, “Any surgical procedure that affects your pelvis and your central nervous system may have significant impact on your sexual response.” I’m struck by the use of the word significant, when what is significant to me is how few surgeons address this aspect of surgery with their patients.
This spring I was speaking with a breast cancer survivor, who had also recently had a minor pelvic surgery, and when she found out about my work as a somatic sex educator, she had a long list of questions for me: “It’s been weeks since my pelvic surgery, but I’m scared to have sex. I’m afraid it will come back. Can you help me with that?” Yes. “My partner wants to touch my breast where I had my surgery, but I’m not comfortable with it. She keeps insisting that she loves my breasts, but I just don’t want to be touched there. Can you help her understand that?” Yes. “It’s been over a year since my breast cancer surgery, but I’m not over it yet. Is that normal?” Yes. And I can help with that, too.
I asked if her medical team had addressed any of these issues. They had not. In fact, in regards to her pelvic procedure, they gave her the impression that she’d be fully recovered in a matter of days, and just said “Don’t have sex for two weeks.” She did not feel fully recovered in a matter of days. And, like the vast majority of patients, she hadn’t felt comfortable asking her surgeon questions related to sexual pleasure and function. Research indicates that most patients believe bringing these issues up is the responsibility of their doctors. Research also indicates that most doctors don’t bring it up. Which is why another thing I do is support folx with medical and sexual self-advocacy as they navigate treatment and recovery.
Coming back to the Mayo Clinic quote with which we began, it goes on to state that the body is “resilient” and that given “time to heal and some loving attention, most people can often become sexually responsive again.” I am in full agreement that our bodies are phenomenally resilient, but the rest of the quote’s focus on the restoration of sexual function and “response” is problematic. It hides the reality that healing our sexuality post surgery and illness isn’t just about function. It’s about body image and identity and trauma resolution and our relationship to our partner(s). Each of these elements are essential and dynamic, and with the application of “loving attention” contain the potential to transform, ultimately yielding even more pleasure after surgery than before. Very often, in the midst of the emotional and physical reality of treatment and recovery, that loving attention comes from the support of a trained professional who can hold space for that healing and offer guidance on how to get there until enough resilience has been restored so as to enable folx to offer loving attention to their sexual selves on their own. After all, humans are hardwired to learn and heal in the presence of a compassionate witness, not in isolation.
I also asked her if anyone on her medical team had discussed scar tissue remediation, and was unsurprised both that the answer was no and that she had never heard of scar tissue remediation at all. Most people haven’t. So what is it and why is it so important?
Scar tissue remediation is gentle, physical manipulation (massage) of a scar, which makes the scar supple and prevents the scar tissue from adhering to the tissues underneath it. Scar tissue is essentially collagen molecules arranged rather willy-nilly to knit severed tissues back together. Typically collagen arranges itself in very organized patterns, which in function with elastin molecules, allows for the movement and elasticity of our tissues. The willy-nilly arrangement of collagen in the scar is not in itself a problem, though it does explain why even scars we work on are not as flexible as the surrounding tissues. The problem occurs when those collagen molecules continue to stack up, adhering to adjacent tissues. Hence, tissues that the scar should be sliding over with ease are now “stuck to” the scar. Unless the scar is addressed, this “stickiness” can continue to grow, extending like a web throughout the body, eventually causing new problems of its own. These adhesions in the body can compromise sensation, cause pain or infertility, and inhibit mobility. Sounds scary, right? But keep in mind that all of this can be prevented non-invasively through scar tissue remediation massage.
Maybe it sounds so scary that you’re not sure you want to believe me. I wouldn’t blame you. I mean, if this is so serious (and preventable), why don’t we all know about it? “Why didn’t my surgeon bring this up?” you may be asking. Yeah, so I don’t have answers to those questions, just my own frustration and confusion. The reality and impact of scar tissue is not unknown to the medical field. The National Institute of Diabetes and Digestive and Kidney Diseases, affiliated with the National Institutes of Health, reports that 93% of patients who undergo abdominal surgeries develop abdominal adhesions in which “bands of fibrous tissue” (scar tissue) “can form between abdominal tissues and organs [in the abdomen].” “Surgery in the lower abdomen and pelvis, including bowel and gynecological operations, carries an even greater chance of abdominal adhesions,” which, over time, “can become larger and tighter…sometimes causing problems years after surgery.” The NIDDK goes on to say, “Surgery is the only way to treat abdominal adhesions…More surgery, however, carries the risk of additional abdominal adhesions.” I’m sorry, what? How is that rational? They also state that abdominal adhesions are difficult to prevent. Unfortunately there is no research on the effectiveness of scar tissue remediation performed as soon as possible after surgery in preventing abdominal adhesions. I propose that this is possible…and that’s there’s certainly (literally) no harm in trying.
And while I’d love to see a shift in our medical culture that supported everyone in receiving scar tissue remediation massage 6-8 weeks after every surgery, it’s never too late to address scar tissue in the body. While massage right after surgery may prevent adhesions, scar tissue can be broken down via remediation massage at any time, including years later when symptoms, such as pain during sex, begin to emerge. Fundamental to the remediation of old scars in particular is the use of castor oil. Exactly how castor oil is so effective in breaking down scar tissue is still somewhat of a mystery, though a number of research studies indicate that it produces a significant temporary increase in T-11 immune cells and exerts “remarkable analgesic and anti-inflammatory effects” on the body. For more information about castor oil and how to use it for self-treatment of scars and inflammation, see my book, Pelvic Pain Clinic.
In addition to its preventative and restorative benefits on our physiology post surgery, I also find that scar tissue remediation massage provides an opportunity to integrate the impacts of surgery on our body image, our sense of self, and our sexuality. Let’s come back to the example of breast cancer. Scar tissue remediation may also help to restore sensation to the breast, which is often compromised by nerve damage and trauma. But, more importantly, it also provides an opportunity to reconnect to this part of the body that has been a source of pain, of trauma, perhaps of shame. It creates a container in which to grieve our losses, to grieve the changes we’ve been through. And from there, when ready, it creates a container in which we can begin to accept, welcome, celebrate and love our breasts, our chest, our body as we live in it today. We are truly in relationship to our body at all times—some of us consciously and some not so much. Regardless of our conscious connection, surgery and illness is a conflict in that relationship. It may compromise our trust in our body. We may be angry with our body. Thinking about our body may inspire nothing but tears and pain and grief. But like any relationship, if we desire to restore connection after a conflict, it takes effort. We reach out. We express our feelings. We forgive. And we get to know each other all over again, from this new place, because neither of us are quite the same.
So what do I recommend for folx after surgery to support sexual integration?
1) Scar tissue remediation. 6-8 weeks after surgery. See a provider for multiple sessions or to learn how to do it yourself. Or bring a friend or a partner and ask the provider to teach them how to provide massage for you.
2) Consider TRE®. It’s common to feel traumatized by the experience of illness and surgery, and too often that trauma is downplayed or ignored. Regardless of whether you consciously feel traumatized by the experience, surgery is embodied trauma. You may not realize the impact on your nervous system of an event for which you weren’t consciously present. But relieving activation in the nervous system increases our resilience, supports our healing, and nurtures a positive outlook.
3) Sometimes just working with the scar tissue and addressing the trauma in the nervous system through TRE resolves a client’s sexual concerns. And if not, it’s time to tackle those directly. A somatic sex educator can provide coaching on how to talk to your partner about sex or on ways to maintain intimacy with your partner when you’re still not ready for physical sexual contact. Maybe your libido has taken a hit, and you’re afraid you’ll never feel sexy again. Somatic sex education offers tools, practices and exercises to help you reconnect with your eroticism, access pleasure, and reclaim or reinvent your sexy self.
Most importantly, only you know what you need. Allow yourself to trust your body and to seek the support you desire for any aspect of recovery and healing.
*NIDDK references from "Abdominal Adhesions.” Retrieved on April 3, 2018, from https://www.niddk.nih.gov/health-information/digestive-diseases/abdominal-adhesions