Pelvic Floor Therapy Undercurrents
The Stories You Don’t Hear About Therapy & Spiritual Conditioning
She came in and sat down, and before she’d even set her purse down, she said: “I’m either having a trauma response or a really big breakthrough.”
One look in her eyes and I knew — it wasn’t a breakthrough.
I’ve been working with women to heal medical and reproductive trauma for many years. I’ve heard a lot. But what this client brought back to me after three sessions of pelvic floor physical therapy (PFPT) stopped me in my tracks — not because it was entirely unfamiliar, but because of how many layers of harm had compounded, quietly and without anyone naming them.
I had been working with her for about two years. While I was away, she became concerned about a possible prolapse and decided to have it evaluated — a self-aware, proactive decision.
The first two sessions with her PFPT practitioner involved visual examination and internal work. My client described it as lacking a sense of reverence or trauma awareness, but based on our work together and her own body literacy, she felt enough safety to return a third time. She wanted to get better. She trusted the process.
What she didn’t know was that the third session would be entirely different.
She had just returned the day before from her father-in-law’s funeral. She told me she’d been spacey, emotionally raw, and by her own description, a little out-of-body. There was no check-in at the start of the session, no conversation about what was planned prior, no information sheet about the procedure or what to expect during or after. The practitioner placed electrodes on either side of her anus and administered electrical stimulation to her pelvic floor — without disclosure, without a consent conversation, and without pausing to assess the state of the person in front of her.
My client described the experience as horrifying. She froze. She could not speak. She could not ask her to stop. That inability to act is not weakness — it is a textbook trauma response. The body, overwhelmed, goes still.
In the two days that followed, she could not function. Deep panic. Inability to care for herself or her family. Profound confusion about what had happened and whether she was supposed to feel that way.
Her nervous system registered it as an assault — regardless of the clinical intention behind it. Regardless of how ‘nice’ the therapist was, or how good her intentions were, her approach was authoritative, out of touch, and ended up being harmful.
This is not an isolated incident.
As someone who works with women healing from medical trauma every day, I hear versions of this story regularly — and I have spent a lot of time thinking about why.
Part of the answer lives inside the institution itself. Western medical training is a system that has long institutionalized patriarchy and misogyny, not just in how it treats patients, but in how it treats the people it trains. Residents are pushed past their limits, conditioned to override fatigue and doubt, taught that endurance is competence and that the body’s signals — their own included — are obstacles to efficiency.
Many clinicians, by the time they are practicing independently, have been quietly traumatized by the very system that credentialed them. They cannot always see the harm they are doing to patients, because no one helped them see the harm that was done to them.
A practitioner who has learned to dissociate from her own discomfort will not reliably recognize dissociation in the woman on her table.
This is not an excuse. It is a context — and it matters, because harm that goes unexamined gets passed down. A system that teaches clinicians to follow protocol over presence will produce clinicians who do exactly that. And again, we women are left to pick up the pieces.
What made me sit down to write this over Memorial Day Weekend is the particular density of the harm in this story — and one additional layer I have been sitting with since she walked through my door…
Before she came to me, this client had spent years immersed in wellness and spiritual communities. Yoga. Plant medicine ceremonies. The kind of spaces that ask you, in various ways, to surrender — to push past resistance, to breathe into discomfort, to believe that what feels hard is actually growth.
I want to be careful here, because I am not dismissing these practices wholesale. But I am naming something that I think goes largely unexamined.
Certain strands of wellness and spiritual culture condition women to override their own distress signals.
When every uncomfortable sensation is reframed as a sign you’re expanding, when “staying present” with pain is spiritualized as a virtue, women lose access to a very important piece of inner technology — the ability to distinguish between a productive edge and a violation.
The cue to “breathe into” what’s painful is genuinely useful in some contexts. It is genuinely harmful in others. Most women are not given tools to tell the difference, and the communities that shape them often don’t offer those tools either. What gets cultivated instead is a kind of noble endurance — a willingness to white-knuckle through something the body is screaming to stop, because stopping might mean you weren’t ready to grow. (This in particular is acutely painful for those of us who identify as spiritual seekers.)
My client unconsciously brought that conditioning into the clinic. She trusted the process the way she’d been taught to trust the process. And when her body went into freeze — a survival response, not a spiritual one — she had no framework that helped her understand what was happening or give her permission to leave.
Women get gaslit in spiritual communities all the time, and it costs us something real: access to our own instincts.
I know this first hand. I’ve been drawn into more than one spiritual cult. The line between growth and abuse gets blurred until it nearly disappears. It’s often intentional that way, to groom us.
And then we walk into a clinical setting — already primed to defer, already practiced at overriding — and the same dynamic plays out in a different color.
True healing, whether somatic, clinical, or spiritual, does not ask you to abandon your body’s signals.
It helps you learn to read them. It creates enough safety that when something feels wrong, you can say so — and be believed.
What this client needed, at every stage, was someone who understood that a dysregulated nervous system cannot metabolize a challenging intervention.
That a person who just buried a family member the day before is not in a state to process electrical stimulation to her pelvic floor.
That consent is not a form you sign in a waiting room — it is a living, ongoing conversation that tracks the person in front of you, not just the protocol.
I know that rushing toward physical intervention is commonplace in the PFPT world. But from where I sit, it is a recipe for dissociation and re-traumatization.
In my own practice, we walk at the body’s pace. We do not move faster than trust. And what became clear to me very early in my client’s story was that her practitioner was following a written protocol — and was not reading the person in front of her. That is a grave mistake when your stated goal is healing. A protocol can tell you what to do next. It cannot tell you whether the person on the table is present enough, safe enough, and regulated enough to receive it.
I am writing this because I believe what happened to my client happens to many women, and goes unreported — and therefore uncorrected. Because the harm is diffuse and hard to name. Because the women themselves often aren’t sure if what they experienced was wrong, having been trained by both clinical and spiritual culture to doubt their own read on things.
I am writing this because she deserved better. And so do the women who never find their way to someone who can help them name it.
If any of this resonates with you, I’d welcome the conversation.
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