In this essay I want to discuss an invisible source of the creation and perpetuation of pelvic floor pain. It is the issue I’m calling pleasure anxiety. This is something we’ve discussed in our book A Headache in the Pelvis and it’s not something, to my knowledge, that has ever been discussed in the research on or in the general discussion of, pelvic floor pain. Pleasure anxiety refers to an aversion toward pleasure because it triggers an unconscious fear that something bad might happen if someone is happy and unprepared for danger. Pleasure anxiety is often seen in individuals who have suffered some life-changing trauma like the death of a parent, or some other kind of traumatic painful experience that occurred when they were ‘unprepared’ for such an experience. I have also observed that it is present in individuals who have not suffered any discernable trauma.

Pleasure anxiety can reach a level of distress in some individuals and Extended Paradoxical Relaxation, the relaxation protocol that we teach our patients to help them heal their sore pelvic floor, sometimes needs to be modified to help someone through this anxiety. This is because EPR helps our patients un-defend themselves. Someone who deals with pleasure anxiety can feel vulnerable and anxious as they un-defend themselves by letting go of their vigilance and physical guarding in the pelvis. Sometimes there is what is called a somato-emotional release during EPR or during the physical therapy trigger point release our patients practice. Occasionally, as people with pleasure anxiety follow our relaxation instructions and their nervous systems begins to quiet down, their heartbeat might increase, their palms begin to sweat and to their distress, they feel more anxious doing relaxation. This reaction occurs because the relaxation is challenging a default psychological defense that says it’s not safe to let down one’s guard and vigilance. With the patients motivation and proper guidance, this reaction can disappear.

Pleasure anxiety is the fear that being unguarded and not defending yourself, leaves you vulnerable and unprepared for bad things.

Here is an example of pleasure anxiety that one of our patients with pelvic pain experienced: A patient experienced the suicide of her mother at a time in her life when she was carefree and happy. The news of her mother’s death occurred suddenly and shocked her. From the time of her mother’s death she began unconsciously to tightened up physically and began walking around in her life nervous and wary. In her mind the experience of being happy and carefree was somehow connected to a terrible thing happening for which she was unprepared. This is the reason I believe she complained that she never could relax.

During therapy with a psychotherapist she noticed that as she grew older and explored her life, she seemed to feel uncomfortable feeling good for very long. She reported that invariably when she felt a sense of contentment, negative thoughts and worries about bad things that might happen in the future would come to her mind and her good mood would evaporate. She reported that she felt strangely naked during the brief moments when her pelvic pain would subside. With practice at having more and more periods of the subsidence of the pain, she learned to tolerate being un-defended during relaxation.

The core of our treatment for pelvic pain is training our patients to profoundly relax their pelvic muscles and calm down their guarded and worried nervous system to provide an environment for the sore and chronically contracted pelvic muscles to heal back to normal. You can’t relax the pelvic muscles without relaxing elsewhere in the body. In practicing EPR, you un-defend yourself; you allow yourself to be at ease and feel good; you let go of vigilance and allow yourself to feel pleasure by both by relaxing muscular guarding and by learning to release the compulsion of ongoing worry. Pleasure anxiety represents an unconscious, if not dysfunctional and unworkable existential strategy for survival. Practicing letting go of guarding both physically and mentally using the Wise-Anderson Protocol can bring you right up against the fear that being unguarded for any period of time is unsafe and to be avoided.

Slowly letting go, further and further into being unguarded for longer periods of time is the key to becoming free from the worry that being unguarded is unsafe. This takes time, intention and trust one’s teacher and the method used. The watchword of pleasure anxiety is ‘It’s not safe to feel safe.’ The result of such an attitude is that the whole body tightens up. In people who have pelvic pain, the pelvic floor is one of the central locations that remains chronically tightened and vigilant. It is loosening and releasing oneself from this guarded state, in which one is protecting oneself from the being open and relaxed in life, that the sore and irritated pelvic floor has the possibility to heal.