In the original version of our book A Headache in the Pelvis, we described pelvic floor pain as a condition in which the tissue of the pelvic floor is caught in an inhospitable environment of chronic contraction, pain, and tension. We stated simply that our therapeutic approach – called the Stanford Protocol by some, and we call the Wise-Anderson Protocol – aims to turn this unhealthy environment into a hospitable one to permit the healing of sore, tightened tissue.

Many years after we originally wrote that first edition, and after treating several thousand additional patients, many new observations and insights have emerged, and we’ve found different ways to describe the onset and perpetuation of this invisible condition.

If you have pelvic pain, and your pelvic floor muscles are locked in a self-feeding cycle of tension, anxiety, pain, sore tissue, and protective guarding, then it’s an important but often-overlooked observation that you are the environment in which this condition exists. You are the environment in which this sore, painful tissue can or cannot heal. As a result, you needn’t be a passive participant to resolving your condition.

I experienced pelvic pain for over 20 years. Every day, I was in pain, distracted, and living with an underlying feeling of dread that I would never recover my life. Inwardly, I felt like a mess. Doctors had nothing to offer me. They told me that my conditions was related to my prostate gland – something I later discovered was untrue – but they also seemed uninterested in my pain, and more than happy to see me leave their office. Knowing what I do know now, I think my sense about the doctors was correct: they weren’t interested in my situation, they didn’t understand it, and they could do nothing to help. In fact, they offered the faulty diagnosis that somehow this was a prostate-related problem for which there was no solution. When you’re a doctor and someone comes to see you with a condition you don’t understand and can’t help, you naturally withdraw. I still clearly remember the first time I went to see a doctor about my pelvic pain. He talked to me, examined me, and very quickly said to his nurse, “Next patient.”

I went to these doctors as an anxious and frustrated patient. I had the idea that my condition was mysterious and arbitrary – that it had nothing to do with the state I was in. I didn’t understand that my inner state had everything to do with my chronic symptoms. But, no doctor I saw understood this either.

What does it mean that my inner state led to my chronic condition? Consider a more straightforward example: if you tightened your hand into a fist for a year, the tissue of your hand would be sore, irritated, and painful. That’s just common sense. Further, if you kept maintaining a fist, this sore tissue would remain irritated and painful – that pain isn’t going to heal. This continually tightened fist is the environment that the sore, painful hand and fingers exist in.

The same situation exists with pelvic floor pain: the patient’s tightened, anxious, nervous state is the environment that interferes with the healing of the tissue. Furthermore, normal activities of life exacerbate the pain and irritation of sore pelvic tissue. Sitting, walking, lifting, and balancing are all potentially irritating to the already sore pelvic floor. Additionally, a subset of people with pelvic pain have post bowel movement pain, post urination pain, post orgasm pain, and even sitting pain – activities that are part of regular life and normally cause no pain or difficulty. With pelvic floor pain and dysfunction, these activities contribute to the inhospitable environment that interferes with the pelvic floor.

And, of course, there is also anxiety, sleep disturbance, and the deep psychological distress that most people with pelvic pain endure. Anxiety and nervous arousal are a huge exacerbator of pelvic floor pain. Gevirtz and Hubbard demonstrated in a watershed study that relaxation quiets electrical activity in trigger points, while anxiety hugely heightens electrical activity.

All of this is what I mean when I say that you are the environment in which your pelvic floor tissue can heal or remain irritated. Our approach asks a very big sacrifice – that patients devote at least two hours every day to applying competent, self-administered physical release and practicing relaxation.

When I had pelvic pain, I went to the doctor and hoped that the doctor would just fix it. I wanted to simply say, “Here it is doc. It’s your problem, now.” A doctor who understood pelvic floor pain would have replied, “You will have to create an environment inside yourself, every day, to allow the sore and painful tissue to heal.”

It’s true that pelvic floor pain can go away on its own without treatment. There are people who practice no self-treatment and just get better. It’s also true that some patients get better in a variety of ways – from doing physical therapy to changing jobs and other apparent interventions. In my experience, however, those people are a small minority of pelvic pain patients. For the majority of patients, no one else can ultimately fix the problem. It’s like brushing your teeth – yes, someone else can show you how to brush and floss, but ultimately there is no one who can do this for you in your life except you.

We are the environment in which our pelvic pain exists, and in my view this environment in which we exist day-to-day is the central factor that facilitates the healing of pelvic pain. Skillfully loosening the relevant tissue inside and outside physically and providing regular and significant daily time in which the body becomes quiet and relaxed is necessary for most cases of pelvic pain to significantly improve and resolve.