My Perineum Reeducation
I'm lying on my back, naked from the waist down, inside a tiny office the size of a large closet. There's a woman with her brown hair tied back neatly into a bun, wearing a face mask and a rubber glove on one hand that has two of her fingers positioned inside me.
"Contract, to the maximum. More, more, more," she says. Her eyes are nearly closed, her head bent in concentration. I feel like how my 2-month-old child feels when trying to use a muscle she's never used before: a bit helpless.
"A bit more, voilà!" she says.
I try to contract my perineum—the muscles that are between my vaginal opening and anus—without recruiting other surrounding muscles as supporting actors.
Welcome to my rééducation périnéale, which loosely translates to perineal rehabilitation in English, though sadly, there really isn't an equivalent process in the United States. Ten sessions of government-funded, free pelvic floor physical therapy are available to women who have given birth in France.
"The rééducation périnéale is a given, something everyone prescribes postpartum once they leave the hospital," said Molly McBride, a midwife at CALM, a birthing center in Paris.
McBride worked in tandem with my other midwife who assisted my birth and came for a home visit a week and a half later. She's also the one who first showed me my stitches, the result of an intense and rapid birth where my daughter shot out quickly, leaving me with a large tear that went from the bottom of my vagina to my anus.
There is no standard practice of postnatal perineal rehabilitation in the U.S., and the subject of giving birth and women's bodies in the aftermath of such a momentous feat is usually gingerly avoided.
The history of the practice has roots in America
Ironically enough, the basis for la rééducation périnéale came from America and a gynecologist named Arnold Kegel, whose last name is now synonymous with the famous Kegel exercises that are most commonly associated with efforts to improve sex lives. But the pelvic floor exercises he pioneered were actually in response to an observation that postpartum women could suffer urine leaks, a loss of sensation and, even more horrifying, vaginal prolapse, or when pelvic organs fall into the vaginal canal.
The solution was to strengthen weakened pelvic muscles, and Kegel first conducted trials around 1948, with other studies following in Yugoslavia and Sweden in the '70s, according to my physiotherapist, Jessica Rozier, of France.
In the 1980s, French physiotherapist Alain Bourcier brought the technique back across the Atlantic, and in 1985, there was a decree that made postnatal rehabilitation covered by the universal healthcare system in France.
But while all French women are fortunate to have the option for free physical therapy for their pelvic floor, not all of them opt to do it.
"I've noted that not all women have the same relationship with their perineum," Rozier said. "Some are discovering it through rehabilitation, others are really familiar with it either through education from their mothers or through their own research online, especially with social media networks…and for some, rehabilitation seems to be something one 'has' to do, like a chore or something taboo."
Indeed, when I talk about going to physical therapy for the muscles that surround my vagina, the range of reactions leans toward discomfort, as if hearing about female sexual health is more painful than whatever the woman is going through herself. Some people are curious, especially when I tell them about playing video games with a probe in my vagina.
"Today's session will be more unique!" Rozier exclaims to me on my fourth visit.
She inserts the probe into me with gel, always asking with the utmost professionalism before and during if I feel OK. This probe is used for biofeedback to measure the strength of my contractions, as well as electrostimulation, which forces contractions in my perineum.
Rozier turns on the laptop, which glows in 8-bit color. I stand up, pull on a pair of shorts and face a small laptop screen, which displays 1990s graphics that resemble a computer game.
"Here you are on this little tractor and your job is to follow the curve," she says. "When it goes up, contract! When it goes down, release. But pay attention—you must be precise!"
In the first few seconds, the game seems bugged. There is no beginning introduction or end, which feels somewhat symbolic of how women's sexual health is treated: shrouded in mystery, with no points to be gained or a larger narrative to work within. The work we must do is so often a burden we carry in silence.
But times are thankfully changing: New medtech startups like Perifit are marketing their Kegel exerciser and app to the millennial crowd, with the near-billion women who suffer from pelvic floor disorders in mind, alongside others such as kGoal and Joylux for menopausal women.
Rozier recommends that people see a professional for a checkup if they experience difficulty restraining their urine, gas or bowel movements, or feel a heavy sensation in the lower stomach or between the legs, pain or pain during sex, or a loosening of the abdomen.
The clock on the game runs out and the screen freezes; my training session for the day ends. My physiotherapist reminds me not to carry my daughter too long while walking, and I bounce out of the tiny office, lighter with the knowledge of knowing my own body better.