‘To work on the pelvic floor, sometimes I have to address the base of the skull first’
Some women have never seen their vulva or experienced an orgasm, they don’t know where their pelvic floor muscles are. There are many who have been made to believe that menstrual pain or pain during intercourse is ‘just the way they are’. Many women suffer in solitude / in silence and solitude because they think they are the only ones who experience this. Is it with them in mind that this book was written?
With co-author Kamila Raczyńska-Chomyn, we have been working with and for women for many years. I met Kama when she came to me as a patient. It turned out that she did pelvic floor training for a living, which no one else in our country did at the time. I, on the other hand, took up gynaecological osteopathy, which people frowned upon too, saying that it was some kind of fanciful whim. So we were brought together by a desire to help women and the fact that we both run against the grain a little bit.
Together, we formed support groups for women and we started listening to women’s issues. What we heard only made it clearer that the road ahead of us was very long. Because even the women who knew they should work on their body were forgetting the importance of its connection to the psyche. And the knowledge about one’s own body was lacking even at a very basic level. I once had a patient whom I showed a pelvic floor model. I said, ‘Here you have the vaginal opening, this is the urethra, higher up you have the clitoris...’ And the patient replied, ‘Oh boy, and I thought it was in a completely different place, that the urethra is where the anus is!’.
This lack of knowledge is due to the fact that no one is really educating us. There are no decent classes on the subject at school, and at home there is still the conviction that talking about the body is taboo.
That’s why we want our book to reach as many people as possible. Although I think that this generational shift is already underway. My parents didn’t talk to me about sexuality either, but my kids already know what a pussy is and what a winkle is. We often go to the naturist beach, because for me, the body is to be loved and treated normally, every part of it. It would be nice if we could start talking about this topic honestly and without restraint. Even though we are facing extremely difficult times and I know that several of the topics covered in our book may be seen as controversial.
But you are not afraid to discuss them. In the introduction to the chapter on pregnancy termination, you write: ‘We believe that the conversation about women’s intimate and reproductive health is incomplete if abortion is not talked about in an honest and straightforward way’.
We really wanted this chapter to be written without appealing to extreme emotions. And I think Kamila succeeded in that. After all, it is not for us to judge women’s decisions; I never judge my patients because we know ourselves only as far as we’ve been tested. And really, saying ‘always’ and ‘never’ doesn’t do any good. I used to think that things were ‘never’ or ‘always’ one way, but life quickly verified it. Life teaches you humility, if only you’re willing to understand the lessons you receive.
I would like patients in my office to talk about terminating a pregnancy completely freely, and it would be nice if more and more doctors and physicians got rid of a judgemental attitude.
You also write about femininity and sexuality after chemotherapy and radiation therapy. You bust the myth that a woman after cancer treatment, which often includes the removal of certain organs, is no longer fully herself. You emphasise that she still has the right to enjoy life in every aspect of it, that she doesn’t have to stand aside.
We talked to a psychooncologist who has been through this herself. We insisted on doing this interview, because nobody wants to talk about this in our country. No one thinks about how patients feel after treatment. They really are sidelined, living with the feeling that nothing more awaits them in life. And yet, after cancer treatment, we still have sexuality, we still have our needs.
Nor does anyone remember to secure the fertility of these women. Literally one in a million physicians tells their patients about oncofertility, and this topic should come up during the first visit! Patients need to know that they can freeze their eggs.
That holistic approach to women that you mentioned, the union of the body and mind, is one of the main tenets of your book. Hence its duality – your chapters deal with medical issues, whereas Kamila discusses emotions and the psyche. In reality, for many doctors, a woman is still only a body.
These two aspects simply cannot be treated separately. The way we live, what we eat, and how we take in stress all have an impact on the functioning of the body. I always tell my patients that life is not stressful, it is stressful to the extent in which we perceive it that way. So there are women who will suffer from more ailments because they worry more and they allow that stress accumulate in the body. And there are those whose psyche works great, so their issue will actually have a strictly medical cause.
The duality comes from the fact that we actually work this way with patients on a daily basis.
Do you often hear in the office that ‘it just has to hurt’?
Yes, women are constantly faced with the myth that ‘it hurts because that’s the way we are’. I always tell them, ‘If that’s what your doctor tells you, change your doctor’.
I remember one of the course participants who came to see me after a birth with a perineal incision, whom the doctor in charge tried to convince that there was no point in going to physiotherapy or an osteopath with the scar, because it would ‘pass on its own’. I wonder what the man would say if it was him who had the area between the anus and the perinaeum cut open. That if it hurts, it’s all right because it will eventually pass?
A wonderful gynaecologist, Tomek Songin, who we talk to in the book about painful periods and painful intercourse, also emphasises this: pain is not the norm. I wish that after reading our book, women were aware of this when entering the doctor’s office.
We often ask ourselves and doctors about pain. But I think few of us have looked for answers to questions such as: ‘Have you ever laughed so hard you peed yourself?’ or ‘Can you pee?’.
Because these are still embarrassing topics. But the truth is that stress urinary incontinence affects one in three women, and although we are starting to talk about it more, we are still moving in the sphere of taboo. And that pain doesn’t have to last at all. If I sneeze and pee comes out, I can’t treat it as a physiological norm. And it would be good to start working on it right away, because it will get worse with time.
Fortunately, Dr Jacek Kociszewski, a urogynaecologist, who helps us answer these two questions, is able to talk about this problem in an extremely light and accessible way, completely understandable not only for physiotherapists or osteopaths.
And is osteopathy still considered an unconventional method?
In Poland, to become an osteopath, one has to hold a diploma in medicine, obstetrics, or physiotherapy. Osteopathy is based on anatomy and physiology. It’s not magic.
In our daily work, we talk about connections that are not obvious to many people, but which are based on science. To work on the pelvic floor, I sometimes have to address the base of the skull first for the therapy to be effective. Because there are anatomical connections between these areas.
Not everyone might fully understand what I do on a daily basis, but fortunately, there are more and more doctors who are able to look at their patients holistically and refer them to me for therapy when they see a need. They act a bit like doubting Thomas. When they hear that a woman was in a lot of pain, and after seeing me that pain went away, they begin to believe that osteopathy does work.
I’m going to stir up a hornet’s nest here and insist that doctors are still failing to look beyond their specialties when dealing with us. When we have a fertility problem, we get hormones. Which doctor will refer us for as much as breathing exercises?
It’s time to finally learn to look at our bodies globally. Fertility is not just about the pelvis, uterus and ovaries. Yes, the uterus has to accept an embryo and the ovary has to produce an egg, but all these organs have to be in good shape for this to happen at all. And not just in this particular area. We also need to keep in mind what’s happening on the hypothalamic-pituitary-ovarian axis. OK, let’s approach the patient medically, let’s check the appropriate hormones, let’s do more extensive diagnostics if needed, but let’s also pay attention to how the patient is doing in general. It might be good to suggest to her that quieting the sympathetic nervous system down and switching to the parasympathetic system would definitely benefit her more. Breathing is worth mentioning – we learn so many subjects in school, but no one teaches us how to breathe... Because if we don’t have awareness in terms of breathing freely, we are in constant tension, our stomach is like a rock. There is no good drainage, so the organs aren’t nourished as well as they could be and function less effectively.
Then where can we look for help? Are there any centres similar to yours outside of Warsaw yet?
I have patients from all over Poland, but, luckily, I can send them to facilities closer to their place of residence, because there are specialists in virtually every major city in the country. We, the specialists, know each other, we participate in training courses together, so I know who to recommend in Kraków or Suwałki.
Can we work on our, for example, pelvic floor muscles by ourselves?
It is important to properly diagnose the problem. There are patients who think they’re training these muscles, but in reality they’re not, because, for example, their head is completely disconnected from the lower body. They don’t understand how they are supposed to activate their pelvic floor muscles.
Nowadays, the trend is to tone everything, so we often do it without checking whether it won’t do us any harm first. Geisha balls, for example, have become very popular. I do not advocate them, however.
What’s wrong with them?
They are usually of a certain weight, so they are heavy. If we insert them into our vagina and start walking around with them in without checking how our muscles work beforehand, we might hurt ourselves. Because what do you do when you put a ball into your vagina and it’s heavy? You tighten your muscles. And then the tension in your body is constantly elevated, which can cause pain, stasis, or dyspareunia (painful intercourse). So we can use them, but in the right way. We might want to start exercising while lying down, so we can get a feel for how the muscles tighten and what they tighten on. The best option would be to see a urogynaecologist first. Such a specialist can recommend the right exercises for us.
Working with equipment is great, for example for patients with said dyspareunia – but everything has to be well suited to the patient’s individual needs.
I started this conversation by asking who “Ona” (“Her”) is for. And in fact, I should have said right away that it’s for everyone. This is probably the first book on this subject on the Polish market that is this inclusive.
We really wanted each and every person reading our book to feel that it was something for them. To be completely comfortable whether they have a uterus or not and regardless of how they identify themselves and where they place themselves on a broad spectrum. “Ona” is also for you.
Ewelina Tyszko-Bury – osteopath. Through her work, she has learned to listen to the female body. For nine years, she has been exploring the ins and outs of working with patients with gynaecological problems
Ewelina Tyszko-Bury, Kamila Raczynska-Chomyn
“Ona”, ed. Znak Jednymsłowem
Author: Magdalena Keler
Illustrated by Marta Frej
The text was published in „Wysokie Obcasy” a magazine of „Gazeta Wyborcza” on 19 February 2022
