When Physical Pain Gets in the Way of Married Life

本站添加: 2026-05-03

[00:00:01]Well, just a second.

[00:00:06]Waiting for the live stream to start.

[00:00:12]Um, yeah, we uh Okay, we're going to go We're going to go live in 3 2 1.

[00:00:50]Hi everybody. We're going to give it a minute here um, just to give it people a chance to join.

[00:00:57]Um, welcome everybody and thank you so much for taking time out of your busy schedule to join us tonight.

[00:01:06]Cuz we have a very important topic to discuss, something that is not enough talked about. So, thank you all so much for joining.

[00:01:19]Um, I'm going to introduce myself.

[00:01:21]Some of you guys may know me. I'm Aaron Hershfeld, licensed clinical social worker based in Monsey, New York, and I am the founder and director of Revive.

[00:01:32]Revive is a group practice uh highly skilled uh and real quality clinicians who really know what they're doing and are really really well trained in uh in what they're doing.

[00:01:47]Um, one of our great clinicians is Moshe Grossman, who um, gave us some time tonight to talk about a very important issue.

[00:01:57]Um I don't have much more to add about myself, so I'm going to um hand it over to Moshe um, to tell everyone a little bit about you.

[00:02:15]Okay, great. Thank you, Aaron. Thank you for having me. Thank you, everyone, for joining. Um it's it's a pleasure and an honor to be talking to everybody um, and especially about such a such an important topic, such a sensitive topic.

[00:02:29]Um, a holy topic. And unfortunately, um, this is an issue of pelvic pain in couples um that comes up and is often um, not dealt with in a way that's most effective and most helpful.

[00:02:43]Um, it's often difficult to find the right help. And so, I'm really hopeful that this webinar will be informative and helpful for people who are struggling or support people who are struggling. Um, I'm a licensed social worker in New Jersey, and I'm also the founder of the Shalva Center for Marital Wellness, which is a collaborative network of licensed professionals who work uh from a multi-disciplinary lens and approach to treat issues of marriage and intimacy uh such as pelvic pain. We work with men, women, and couples.

[00:03:14]Um, and we're also in R'tza Sham going to have uh lots of available resources online through our website. Um I'm really hoping to just add to some of the great work that's already been done. And I should add that there's uh historically, there hasn't been um, a great amount of awareness or access or understanding of the issue. There've been a lot of wonderful people in our community and beyond that have done great work in this. So, thankfully, um, understanding is spreading.

[00:03:42]Um, and at Shalva, we're hoping to do our part to add to that effort.

[00:03:48]Amazing. I'll take that as a Yeah, thank you so much, Moshe, for being with us tonight. And thank you, everyone, again, joining us. Um Moshe, I'll uh have you start with your presentation.

[00:04:02]Um, and I'll be enjoying from behind the scenes.

[00:04:09]Okay, so I will pull it up.

[00:04:12]And we will get started.

[00:04:27]Looks like it's taking a minute here. Do you see anything?

[00:04:30]Not yet, but Oh, something is coming. Yeah, okay.

[00:04:36]Okay.

[00:04:40]Um, okay. So, the topic tonight, dealing with pelvic pain as a couple.

[00:04:44]Um as I was saying before, it's a really important topic, really difficult topic, and a topic that is sometimes hard to get good information about. Um What's the goal tonight?

[00:04:56]To provide understanding, to provide clarity um, about how pelvic pain impacts relationships um, and how couples can support each other as they're going through this issue, as well as when they're going through the process of treating it and um getting better, hopefully. Um, and how the supportive process is also part of facilitating the healing.

[00:05:18]Um as I mentioned before, this is a multi-disciplinary approach to healing, and we'll get into some of that in a minute.

[00:05:27]Um, but in my experience and from my lens as a couples therapist, um, I view this primarily through a relationship lens. Um, and it's really important that when this issue is present in the marriage, um, that a couple is approaching this issue together. Um, there are feelings on both sides, and there are feelings that come up together in the dynamic of the couple. And understanding how both spouses can be there for each other to help each other to address this issue is really really important.

[00:06:02]Both to facilitate finding the right healing, getting good help, but also it's it's a it's a part of the healing itself.

[00:06:10]So, and just to start with some general um, educational ideas, just a general overview of what is pelvic pain or chronic pelvic pain, as it's sometimes referred to, um, it is a persistent and recurrent pain in the lower abdomen or pelvis.

[00:06:23]>> Just one little Just one little announcement, and sorry for cutting you off Sure. Uh, I just want to remind people that there is a Q&A um, option when you go to the bottom of your screen, you can ask questions throughout the webinar. You can check off the anonymous check box to ask your question anonymously, and we'll try our best to get to the questions at the end.

[00:06:48]Uh, that was it. Sorry. Okay, no problem. Thanks for pointing that out.

[00:06:54]Um So, pelvic pain refers to um, this chronic persistent uh recurrent pain that happens in the lower abdomen or pelvis. This can This can occur various different times um, in various different settings with various different functions, or even when nothing is happening, there the pain could be experienced. Um, the focus tonight, um, being that we're talking about couples, um, is when this pain shows up during intimacy.

[00:07:23]Um Now, this pain from from the get-go, just going to make sure it's clear, this is real pain.

[00:07:32]Uh, unfortunately, I heard a a stat recently that uh somewhere close to 40% of women that go to their health care providers uh and report pain are told that it's just in their head. Um, they're given some pretty shallow, dismissive advice like you know, drink some wine to relax, or just relax, or you know, think about something else. Just really un uh unhelpful and um uh really invalidating responses that unfortunately people get. And it leaves them feeling, you know, obviously very lost, very confused, and misunderstood.

[00:08:06]Um, the pain could be intense. It could feel like a burning or stabbing or bruising, something like that. Um And we're going to get into uh just a general overview of diagnoses and treatments, and then talk more about how we understand pain and why that's important when we talk about approaching it as a couple. Um but one thing that's important to point out, I think, from now as we talk about pain with intimacy, um, that pain can start before intimacy.

[00:08:34]It can come up after intimacy.

[00:08:36]Um, and that's one of our indicators that we have to really think about what this pain is and what pain is in general in order to understand how we're going to address it.

[00:08:46]Um Just a few of the common diagnoses.

[00:08:49]Again, there could be many conditions that can come up um, that one of the symptoms can be chronic uh pelvic pain or acute pelvic pain, but we're focusing on the chronic idea, the fact that it's where the the case where it's more kind of long-term, spanning several months, um happening with some regularity, uh not necessarily every time, but some of the time, um, at least, and it's distressing.

[00:09:14]Um, so on the screen, you can see this is a just a few different diagnoses that people may be familiar with. That sometimes they'll go to a doctor and they'll get a a check and they'll be given this name, and they'll be given different ideas for what it might mean or how they might treat it. Um and um, the pain varies. So, there's a different sensations of pain that sometimes the pain is experienced uh different parts of the body at different times.

[00:09:39]Um, so again, not getting into the specifics of, you know, what the the understanding of on the biological level of what the pain is, um, but certainly that um, the muscles in that in those areas are definitely um, engaged in a way that creates this really difficult, um, experience with intimacy.

[00:09:59]Um, what kind of treatments are available?

[00:10:02]So, again, general overview, very, very broad. Um, sometimes individual psychotherapy or sex therapy is indicated. Uh, that should start to make more sense as we go along here. Um, for those who are wondering why you would see a therapist for a physical ailment. Um, couples therapy, which will be certainly a lens that we're going to be looking through today, um, is also often part of what is uh, recommended or at least needs to be considered when dealing with pelvic pain, um, which we will see more about in just a moment. Uh, pelvic floor physical therapy, this is a trained physical therapist uh, with special training in working with pelvic floor muscles, um, and they can help directly target the physical, um, the physical areas where there is pain, which may be resulting from muscle tension, and, um, help to work with those muscles to release some of the tension and therefore help with the pain. Um, that all these things, of course, are case-by-case, they're highly individualized, and a competent provider or uh, guide needs to needs to be involved in order to help a woman and a couple understand all these options, how they're specifically relevant to their situation based on a thorough understanding of relevant background and symptoms and presenting problems. Um, and then to go ahead and make a recommendation and help the couple to understand how they can move forward in the ideal way. Um, there are more invasive interventions that are available.

[00:11:44]Um, I'm not going to get into those tonight, but they're certainly out there and certainly worth knowing about should the need arise.

[00:11:50]Um, but the bottom line is for all of this, a multidisciplinary approach is crucial. Um, we are complicated people. Uh, we have a lot of deep layers to ourselves, and when there's something showing up in our bodies in a chronic way, um, especially when it's in uh, this sensitive area of life and the body, it's really important to keep in mind that our whole selves need to be uh, looked at when we're going to think about addressing the issue.

[00:12:22]So, what is pain? And this should answer the question of why um, a mental health professional might be involved.

[00:12:32]So, pain, all right, one second. This screen is blocked just a bit over here.

[00:12:37]Um, pain is the brain's way of alerting us to a perceived danger.

[00:12:44]Um, I think for a long time it was thought and believed and still many people believe that pain somehow results from something physical happening. Um, someone gets a cut on their finger, so the reason why it hurts is because the skin was split, and so that's pain. Um, you know, if someone has shown breaks a bone, the bone broke, so now there's pain.

[00:13:07]Um, in in recent years there's been a lot of wonderful studies that have been done to understand more about what pain is and how it shows up and why it shows up. Uh, there is a group called the International Association for the Study of Pain, and they highlight that the definition of pain includes a response, an emotional experience, and a sensory experience associated with actual or potential tissue damage. And that word potential is really key because potential means nothing's happened.

[00:13:39]Um, just there is a an assessment done by our brains, which our job their job its job the brain's job is to keep us safe and keep us alive and functioning well. Um, if there's an assessment that something is dangerous, um, it can alert us to that danger by generating pain, even if nothing nothing's happened.

[00:14:00]Um, we always say that it's really then the first thing when dealing with pelvic pain or any sort of physical condition is to rule out a physical abnormality with a proper medical evaluation.

[00:14:14]And there can be physical issues that cause pain with intimacy, and sometimes it could be fixed, and then the whole psychological piece may be completely irrelevant and great.

[00:14:27]Um, this is talking about or we're talking about when a woman has gone in evaluation, she's gone an assessment from a competent health professional, and is told that there's nothing wrong. Everything is fine.

[00:14:40]Um, you know, and then sometimes it follows with, you know, it's in your head or just relax, drink some wine, whatever it is.

[00:14:48]Um, and that's that's where things get really frustrating. So, um, when um, we have ruled out a physical cause and now we're still left with pain, it begs the question, what is the matter?

[00:15:01]Why is there pain? Why does this hurt?

[00:15:05]Um, so it's a couple's issue, this pain.

[00:15:12]Why?

[00:15:14]Because intimacy is both a physical and an emotional experience.

[00:15:20]Um, now, just just said by way of like a muscle, sometimes I tell people like um, when you cry, is that a physical or an emotional experience?

[00:15:34]The answer is it's both because crying starts usually with an emotion, sadness, happiness, joy, fear, um, that happens somewhere where we can't see it, and it's we don't it's not out external, but then our body responds with our face changes, voice changes, our body tightens, tears come to the eyes wet, physical tears come out of our eyes in response to some sort of a a thought or feeling.

[00:16:08]Um, that's a fascinating thing.

[00:16:11]And when you think about it, it's not so fascinating because our brains are part of our bodies and they interact, and so the brain can create this physical experience.

[00:16:21]So, when there's pain with intimacy, we're looking at a body experience real pain, it's it's 100% real, and yet there's nothing physically abnormal that should be causing it.

[00:16:33]So, then we go and we look at the mind.

[00:16:36]And we say, is there something in the mind that is causing the body to react in this way?

[00:16:46]The emotional piece of intimacy is very much rooted in the couple's relationship.

[00:16:53]And we're speaking about marriage here.

[00:16:55]Um, and that is where I focused my studies and have had my experience.

[00:17:02]I believe it should be true even if such an experience occurs outside of marriage.

[00:17:06]Any time there's two people that are interacting, they're going to feed off of each other, and they're going to have an impact on each other.

[00:17:12]And then the body responds not just to my own feelings, not just to your presentation, but to the shared space between us that happens because we're together.

[00:17:23]And so now I have this experience that includes myself and my history and my thoughts and feelings, my husband's, how they play off each other, and somehow the result of that is pain.

[00:17:38]And so that Mhm, leads me to believe that and not just me, others too, um, that there is something that is happening in the couple's dynamic that is at least relevant to the pain, at least contributing to the pain, if not the cause of the pain.

[00:17:59]Now, this puts a lot of like weight on like, oh, are they doing something wrong? Is he doing something wrong? And we're going to get into some of that soon.

[00:18:08]Um, individual interventions are also valid.

[00:18:12]I want to make sure that's clear.

[00:18:13]Individual sex therapy, psychotherapy, um, can be super helpful. And many wonderful therapists do that work individually, and it works. So, I don't want to make it sound like the couple's approach is the only way to go. It's certainly not the case.

[00:18:29]Um, as a couple's therapist, this is where my mind goes to first.

[00:18:34]And I think that when we can again, kind of keep that picture in mind of I have an individual who has thoughts, who has feelings, who has um, a history of their thoughts and feelings about intimacy, who may have past experiences, negative experiences, neutral experiences, lack of education, lack of understanding, all sorts of things, a sense of pressure and obligation, layers and layers that go into each person's approach in intimacy, and then that interacts with their spouses.

[00:19:11]And add to that the fact that we're talking about this here on this webinar, but this is really not something that many of us are comfortable having a discussion about.

[00:19:21]So, I'm having this experience, I'm not even comfortable knowing that I'm having this experience and these thoughts and these feelings because I've just gotten used to not thinking and not really honoring and knowing the way I feel about these issues. And I'm certainly not going to share it with my spouse, I'm not even aware of it myself. And if I am aware of it myself, so I'm a step closer, but still to talk about these things openly in this way, it can be really hard. So, all of these feelings and all these experiences end up not being acknowledged, but still showing up in the couple's dynamic.

[00:19:53]And then if the result of that on some psychological level is a lot of discomfort or a lot of fear or a lot of negativity or a bad experience with intimacy, it can then trigger the body to protect itself. Like we said before, the brain sends pain to alert us to danger and to protect us from the danger.

[00:20:12]And so if intimacy is dangerous, a great way to keep us out of danger is to make intimacy not possible through pain. Sometimes the condition is such that intimacy isn't even possible.

[00:20:23]Penetration can't happen. There's a real serious tension and spasming of those muscles.

[00:20:28]Um so if we can bring an awareness and a a a a thorough like a deep dive, a compassionate, a gentle, a sensitive deep dive into the nature of the thoughts and feelings that are maybe contributing to this issue, we can then create a safety in this area of the between this between the couple so that their bodies and their nervous systems can relax and the experience of intimacy can be pressure-free and safe and then pleasurable.

[00:21:03]So the challenge is if I haven't said enough challenges at this point um is because couples um either don't have an understanding of what's happening when there's pain or they just generally don't feel comfortable communicating about intimacy. So there's a lot of these deep feelings that get that come up somewhere sometimes known, sometimes unknown that are deeply, deeply, deeply painful.

[00:21:28]And a couple a few of them I put here. I mean, there could be many more.

[00:21:33]What happens if um a couple is experiencing pain, but the husband doesn't know what to do with himself. And this is especially true when it comes to from couples because and we'll get to this a little bit more in depth later, but there's often the pressure and expectation that even if something is not right, we're going to continue.

[00:21:54]And how can that happen can you see it hurts?

[00:21:58]A woman might be feeling like she doesn't matter now. You're putting yourself before me. How how are you continuing to do this?

[00:22:05]If you know it hurts, you obviously don't understand me and you wouldn't be doing this if you loved me. You wouldn't be doing this if you cared about me.

[00:22:14]How how is it that this is happening to us?

[00:22:18]And so you could see just in those kinds of thoughts. This is not just me internally, just the individual internally, but this is about us.

[00:22:25]Is there something happening between us?

[00:22:27]Is there is there some way you feel about me? Is there some way that you don't understand me that's leading us to be in this experience where I'm continuing to suffer and this is going on.

[00:22:35]>> [clears throat] >> Very, very, very straining on the relationship.

[00:22:40]And then there's one of many or two of many individual thoughts of I I'm I'm a bad wife. I don't want to do this, but I'm supposed to do this. I have to do this.

[00:22:52]I and I there must be something wrong with me. I must be bad.

[00:22:57]Lots of really, really difficult, painful feelings that can come up that really um are obviously really not good for the relationship, but they then as we'll see soon, perpetuate this cycle where the brain believes that there's danger and the brain tries to protect us from the danger with the pain.

[00:23:16]So it's so important for a woman who's experiencing this experiencing this to understand and to get the validation how real this experience is, how valid her feelings are, and how deeply painful this is for her when she thinks about herself, when she thinks about her relationship.

[00:23:32]What can be super, super challenging is the next slide which is what it's like for him.

[00:23:43]One of the hardest things with couples when there's a struggle uh when there's conflict in the relationship can be uh the difficulty of being able to acknowledge that the other person also also has a valid amount of a valid feeling and experience with their distress when my distress feels like it's so unbelievably huge and overwhelming.

[00:24:08]And when we go to acknowledge the experience of the man in this uh struggle it can create feelings for a woman of how could any of that be valid?

[00:24:22]Do you know what I'm going through?

[00:24:24]And I just want to honor that and validate that and there's a reason why that comes up for a woman or any spouse in any situation where there's conflict because it is really hard to acknowledge that the person who's hurting me really has hurt themselves.

[00:24:39]Because what about my hurt?

[00:24:41]So I want to just put that out there before we talk about the men and say that when men when men are in this situation, it also carries an equal amount of pain, emotional pain and frustration.

[00:24:53]Again, religious men men in particular, do you not realize how stuck I am? I have no other option.

[00:24:59]And if you're telling me you don't want this I guess it's something I should add is sometimes it's not clearly communicated that there's a problem. Woman may try to hide it or downplay it or okay, so it's it's getting in the way, but we'll still try as much as we can.

[00:25:15]And so there's still this expectation and this feeling of we're going to continue as much as we can in the normal way but it's it's not the experience that the man is looking for.

[00:25:25]And he's getting not getting what he feels like he needs.

[00:25:29]So he's frustrated.

[00:25:33]He's stuck.

[00:25:35]There's often an assumption, especially early on in marriage that this is um something that is supposed to be happening.

[00:25:46]And this is something that there's been all this build-up for all of my life.

[00:25:53]I've worked on myself to be kodesh and to wait until there's a holy outlet in the healthy way of experiencing this.

[00:26:02]And now now you're saying no?

[00:26:05]Now it's not okay? What what is going on here?

[00:26:11]Extremely confusing and distressing.

[00:26:17]And then there's the individual piece.

[00:26:20]Right? We could see in these two the same way that we showed with the other slides what the woman's experience may be like that here in these two uh on the left the the left one in the center one you don't understand my struggles, my needs. You me, you me. There's something wrong with us, we. This is a relationship. This is a couple's experience. Together now we're stuck in this dynamic where we we're not feeling understood and we're feeling all this pain and we don't know what to do with it.

[00:26:46]And then there's this experience that men have in these thoughts that they have and things that they're sometimes told which there is a time and place for this type of of hashkafah and this type of approach.

[00:26:58]And then there's when it becomes like a a sense of guilt and shame. Like I what is wrong with me?

[00:27:04]How could I still want this if she's in pain?

[00:27:07]I love her. I care about her. I do, but I still what and it's so confusing and it must be that I'm there's something I'm some sort of a monster and I have to learn to control myself and I have to work on myself and I shouldn't be wanting this in this way.

[00:27:21]And that can add all this shame and guilt for him.

[00:27:26]And we may touch on a little bit later what kind of secondary issues can arise for a man when intimacy is fraught with all this stress and all of this tension because of the pain and the dysfunction that they're experiencing.

[00:27:40]We end up in this kind of really painful cycle.

[00:27:44]Um and really with a cycle you can kind of start from anywhere in the cycle.

[00:27:47]Um I'm going to start from the top middle over here.

[00:27:50]Um the woman feels that it hurts, so I don't I don't want this.

[00:27:56]Um or maybe I I want it in some way. I wish I wanted but I I can't practically want it because it's painful.

[00:28:04]When there is um a lack of complete openness or at least optimal openness and vulnerability that feels safe and that doesn't get communicated, a message can be sent to him which is I guess she's not interested.

[00:28:23]Something's off here. She's not really engaging. I I guess I'll keep trying.

[00:28:27]What else am I supposed to do?

[00:28:29]To which she responds, no, it hurts. Or even worse pretending it doesn't and going through that experience when it's not supposed to be that way.

[00:28:38]Um so she says no and and he is rejected and he's angry and he's what is going on here?

[00:28:47]She sees his anger and frustration and how she's feeling guilty and shame.

[00:28:52]What's wrong with me? And maybe I should just push through it and it's not so bad and I have to do it and he's not going to be there for me and he's going to be distant and but it So what what does that tell the brain?

[00:29:05]It tells the brain that yeah, this experience is fraught with danger. It's fraught with physical danger cuz you see it hurt, right? It happened once and now it'll happen again and you see it it's it's not okay. It's not pleasurable.

[00:29:15]It's not safe. It hurts.

[00:29:18]So the hurt continues.

[00:29:20]And then there's the sense of my husband is putting me in this situation. How does that make me feel about him? And now the husband becomes a danger.

[00:29:28]So intimacy is dangerous and the husband is dangerous and it becomes this really, really difficult loop to work through.

[00:29:36]On his end uh similar cycle, just some different words.

[00:29:43]This this can continue to happen and she's left with this feeling of like my pain doesn't matter to me and I have to just ignore it.

[00:29:50]But she's left unsatisfied and he's like, well, I guess my needs don't matter to her. She doesn't seem to care enough to do this for me.

[00:29:57]Her body will go into protection mode.

[00:30:01]He sometimes can get the sense of like, I I got to get my needs met. She feels like she's not cared about and just around and around it can go and the result could be this really frayed connection where neither couple feels understood and they don't feel like they're getting their needs met and that their spouse is there for them in this most sensitive way.

[00:30:23]I want to emphasize again I think I said this already. I hope I did. I'll say it again now that some of these the cycles that I'm I'm describing and the feelings that I'm sharing are often not outwardly expressed and it could be like this image here of the rope that's broken except for a small little strand that's keeping it together.

[00:30:44]Um, that's not the way it even looks or feels on the outside.

[00:30:48]The couple could still have a sense of we have a great relationship and they really do. Outside of the bedroom and lots of other ways, they're there for each other. They're supportive of each other. They listen to each other. They care for each other. Even in intimacy, they do. They really do.

[00:31:03]But somewhere deep inside, there's something that's off. There's some sort of fear. There's some sort of discomfort. There's some sort of strain.

[00:31:12]And that is where the unexpressed feelings the unexpressed feelings then manifest sometimes in that physical physical dysfunction.

[00:31:26]I want to say again to the men out there who may be watching having a desire having a need does not make you a bad guy.

[00:31:36]I at least I don't believe so.

[00:31:38]It's really really difficult when this need can't be met. There's talk out there, is this really a need? Do men really need intimacy? They could function without it.

[00:31:49]Um my thought about that has been, you know, what what then is a need?

[00:31:55]Um, and this may be controversial.

[00:31:57]People can feel free to disagree.

[00:31:59]Um the only thing I think that are really really really needs are air and water.

[00:32:06]If a person can't breathe, they can't live for very long. A person doesn't have water or food, they can't live for very long. But beyond that you know, what what's a true need to the point where you should be okay living without it? Shelter is one of them, you know, one of those things that are considered a basic human need for good reason.

[00:32:24]But I can argue that people live without shelter. Very very difficult, but they can do it.

[00:32:28]All over the world, people live in very primitive ways. People are homeless.

[00:32:32]They don't have a place to live in and they survive.

[00:32:35]So it's hard to survive there, so move to a warmer climate and you'll figure it out. Push through it. Be strong.

[00:32:40]I don't I don't think anybody would say that.

[00:32:43]Um and yet men are sometimes given the impression that when there's issues with intimacy and generally with intimacy in general you know it's a beautiful thing. It's a midst of it's wonderful for a marriage. It's something that every couple should have.

[00:32:58]But if there's something that's not working, you could get over it and you'll be okay without it. Yeah. Yeah, you could be okay without it, but you also really aren't that okay without it. And what couples I think need to understand is sometimes there's a belief that this is like a bonus. This is something that, you know, is really nice when it works, but who knows if we don't have it.

[00:33:18]Okay, it's fine.

[00:33:20]Um, and that is true if there really is no other choice. You could have a wonderful relationship without this.

[00:33:27]And yet there's so much more in the relationship when there is healthy intimacy.

[00:33:32]Intimacy, like we've we've said, is a physical and emotional experience combined in a lot of ways. In a healthy intimacy relationship, it's an expression of the deep emotional feelings that manifest in a physical way to create an experience between the couple that is beyond what could happen without that experience.

[00:33:52]And a desire for that on either spouse's end is healthy and good and for a man too, it's healthy and good. You're not a bad guy for wanting it.

[00:34:11]Two things are true at once.

[00:34:14]Men have needs.

[00:34:16]One thing I want to add also, just talking about the men, is that men are sometimes stereotyped and simplified oversimplified as being just interested in the physical experience.

[00:34:28]It's not true.

[00:34:30]Certainly there's a men lead with that experience more than women tend to do and there's certain things biologically that make it that way and that is accurate in a lot of ways.

[00:34:38]But to dismiss the emotional component of what it means for a man to have this experience with his wife is really to deny a whole part of himself that's very very human.

[00:34:50]Men feel connected.

[00:34:52]They feel loved.

[00:34:55]They feel good about their role in this marriage if they're able to provide for their wife in this way.

[00:35:00]That's an emotional need.

[00:35:05]They have emotional needs. They have physical needs.

[00:35:08]And so do women.

[00:35:11]Women have real needs, especially a woman who God forbid is suffering in pain from this.

[00:35:18]She needs to not be in pain.

[00:35:21]She needs to know that her husband understands that this is not okay.

[00:35:27]It's not okay. It shouldn't be this way.

[00:35:29]She needs to have the space and the safety to go through a process to help the mind and the body to relax into the beautiful experience of intimacy.

[00:35:41]And she needs her husband to be there with her a thousand percent.

[00:35:46]And couples who are able to provide that emotional support to each other as they're addressing intimacy issues not only enhance their relationship by showing up and being there for each other when they need each other the most.

[00:36:00]You're there for me in my most difficult time. When it was hard for you, you were still there for me.

[00:36:05]What that does for a connection is immense.

[00:36:09]But not only that it's a part of the physical healing.

[00:36:15]Because of everything we've been saying.

[00:36:18]The relationship is the context in which the intimacy takes place.

[00:36:23]And the thoughts and the feelings about the relationship can have an impact on how the intimacy experience feels on the physical level with the pain.

[00:36:33]There are individual features also. And those sometimes have to be worked through too individually. It's not to be We're not neglecting that possibility.

[00:36:42]Focusing on the couple's role and the couple's experience.

[00:36:48]If I'm in a relationship where I don't feel safe and my brain has associated my lack of safety with my spouse if I feel safe with my spouse, I feel understood and I feel like I can show up as I am with all of my thoughts and feelings and my physical and emotional needs, I'm safe.

[00:37:08]The body doesn't need to get tense anymore cuz the brain doesn't need to protect it anymore.

[00:37:12]It can just relax and be open to the sensations that come with a beautiful physical intimate experience.

[00:37:23]You're a team.

[00:37:26]Two things are true at once. You both have your thoughts and feelings. It's hard for both of you, but you are a team.

[00:37:33]That frayed rope needs to be tied together.

[00:37:36]The ends will come closer.

[00:37:38]And as a team, the couple will address this issue.

[00:37:45]So just some practical pointers both for for him and for her and again each of these situations is highly individualized. It's um case by case and every person is experiencing this does would benefit from having their own individual attention so that they can help make sure that they're showing up in the way that's most helpful for their uh their spouse to heal this this pain.

[00:38:09]Um some general suggestions for him something I call being actively passive and I I I want to throw that out there cuz I like how it sounds.

[00:38:19]Um, and explain a little bit what I mean by that by taking a step back first and talking about one of the treatments that is used uh for treating pain is as we mentioned pelvic floor physical therapy.

[00:38:32]Um, that involves using any sort of not any sort of I should say. Some very specific ways of introducing sensation to the parts of the body that are experiencing pain and slowly helping them to feel comfortable and safe with those sensations. It's a very gradual process.

[00:38:49]Um it's not about just getting used to the feeling. It's about um helping the body to learn safety with that sensation. So it's really important that there's a feeling with Sorry, with the husband that the safety is there.

[00:39:04]Um those the physical therapy the physical therapy process often includes home exercises.

[00:39:11]And part of what will help those home exercises go well is when the husband is actively passive as a participant.

[00:39:18]He is present but makes makes it clear that his presence is in whatever way his wife needs it to be.

[00:39:28]If you want me to be close I'll be close.

[00:39:31]I am here for you in whichever way feels best. If you want me to take a step back I'm happy to take a step back. I am here for you in the way that you need.

[00:39:39]I'm not not to be on top of you. I'm not going to be pressuring you. I'm not going to be checking in. I'm not going to be insinuating that you need to do this and how's the progress going and when's your next appointment unless I'm asking that because I'm here with you and because you've helped me to understand how it is that I'm most helpful to you if you want me to be part of it in this way.

[00:40:00]Man needs support whether it's reaching out to um somebody, a family member in an appropriate way, a mentor, a rabbi, a chosson rabbi, a therapist, somebody who can offer that support and the validation that what you're going through is extremely difficult. No, it's not normal. No, it's not how it should be.

[00:40:18]Um and yes, it's really hard.

[00:40:21]Um and that can be really helpful.

[00:40:24]Um nurture yourself. Um when there's pain, there's often less intimacy. Sometimes there might have to be discussion about pausing intimacy altogether which can be super super super difficult and has to be taken very very seriously and navigated with a lot of a lot of thought.

[00:40:44]Um but nurturing yourself when you're going through that experience can be really helpful.

[00:40:51]You know, if it's um grabbing a Danish in the morning on the way to work or to college. If it's um I don't know, taking an extra few minutes in the shower, uh getting up early before everybody else so you have some quiet time in the house.

[00:41:05]There's things that you can do um to just make yourself feel like you you matter and you should get the care that you need for your emotional needs even when your physical needs aren't being met.

[00:41:18]Um adding physical and social outlets can be really uh helpful physically to get out some of that physical energy that's getting pent up when there's a uh there's limited intimacy and socially like we were talking about, this is a relationship.

[00:41:32]We need connection. Our most important relationships are those with our family and our spouses.

[00:41:37]Um but that's not to the exclusion of other connections and the social outlets don't have to be with, you know, talking about this issue. It could simply be you know, going out with friends just having a good time somewhere every now and then to just get that feeling of connection so that you feel supported, you're not depleted and you can remain actively present and engaged with your wife who needs you so much in this situation what she's going through.

[00:42:04]And for her support you need to know that you're not bad. You need to know that this is not supposed to be like this. You need to know that there's hope.

[00:42:15]You need to know that there's that even though you don't feel okay it's going to be okay and you can feel okay hopefully soon.

[00:42:27]Get that support. Hopefully as a team with your husband you'll be able to get that but from others like I said, the college teachers or therapists or family members, somebody who you feel like you can trust with this.

[00:42:37]Um be sincere by your efforts to address the issue. Unfortunately, sometimes people have this feeling of, you know, I don't I don't need this so I'm just going to ignore it because it hurts.

[00:42:50]That's going to be difficult in the relationship and if that is a woman's feeling, there's probably a good reason why she's feeling that way.

[00:42:58]And that also needs to be honored and respected and taken very seriously. Why would somebody not be interested in having such a beautiful, wonderful experience? There's got to be a good reason for it. Is it just because of the pain or is there something else?

[00:43:12]Let's be curious about it and let's work through it.

[00:43:15]Um when there's time and when there's um something in place, a relationship feeling between you and your husband that you are together, you do feel like you're a team, share with him. Share your feelings with openness, with softness.

[00:43:31]I'll listen. I want to listen.

[00:43:33]He's feeling understood also. You're both feeling understood together as a team.

[00:43:38]It's really hard for him, too. It really is.

[00:43:41]The fact that it's hard for you doesn't mean it's not hard for him and the fact that it's hard for him certainly doesn't mean it's not hard for you.

[00:43:47]They're both really really difficult and you're both really struggling.

[00:43:51]One other thing, make sure that he knows it's not about him unless it is and God forbid there's a severe issue in the relationship where um there is a problem that's happening where there's um I guess not to go into specifics of what that could be um but assuming that the relationship is otherwise healthy um it's not because of you not interested in him it's not because you don't want him but there's something going on in your mind and your body that's making it that you just can't.

[00:44:21]You love him.

[00:44:22]You want this to get better so that the two of you can have the relationship that you both desperately crave.

[00:44:29]Um and you respect him, you appreciate him and you're committed just like he is to doing this together as a team.

[00:44:41]Um I see that there's some questions in the chat so I'm going to take a peek at those in a minute. Um If anybody has any feedback, uh questions, concerns, comments or just wants to get in touch for some more information, please feel free to reach out to us.

[00:44:57]Um we have we have website shalvamarriagecenter.com uh an email address [email protected] and we also have a phone line and that phone line has a dedicated men's and women's line.

[00:45:08]Um and you'll get that menu when you call. Um and our goal at Shalva just in quick summary is that nobody should ever feel like they're alone in this again.

[00:45:18]It's hard to get help.

[00:45:20]We may not have all the answers. It may not be right away but you're not alone in this, men, women and couples together.

[00:45:27]Um there is there is what to do about it and there is hope.

[00:45:35]With that I will stop my share and I think One That was amazing. Thank you so much again Moshe for that presentation. Um I think we could have changed the title for this not just uh physical pain but like um just in general like you covered so much about um intimacy in general and um sex in marriage in general.

[00:46:06]Um but that was this was an amazing presentation. Thank you.

[00:46:12]>> Um yeah, uh so let me look at some of the questions that came in.

[00:46:18]Um but before I do that if I can just share a little bit of my own thoughts um first of all um it was it's really really validating to hear, you know um someone like you uh discuss this and and explain this that it's not all in the mind, it's not all made up.

[00:46:40]Um and it's shocking to me um you said there's so many um such a high number of people that are told by professionals that this is just in your head or just to have some wine and it'll be better.

[00:46:57]Um that's really sad um knowing that and I'm glad that we're able to you know come on here and let people know that it's not the case.

[00:47:11]Um and also it's fascinating though how you explained you talked about how physical pain um has like has a lot to do with you know, psychological.

[00:47:26]Um Yeah. And you you mentioned like when the relationship is better uh and there's more safety and there's like less um perceived threat, I guess. So the muscles feel relaxed and it can become less painful.

[00:47:43]Um which makes a lot of sense. I think there's another piece which um someone maybe you're familiar with this uh study. There's a study done with like physical pain um where people would be put into like MRI machine to where they would monitor brain activity um they would let let people they would shock people through a physical shock so that they have physical pain. And the study showed the study showed very clearly that when they had someone um say someone that they loved um hold their hand the physical pain was was much less painful. Right. Right? Um so even that, just thinking about it from that angle, like when you were in a relationship and you do have a safe partner even that can reduce any physical pain.

[00:48:41]Also uh much more um a lot of that can be much more much more tolerated.

[00:48:50]Yeah, 100%.

[00:48:51]Yeah.

[00:48:53]And and also like I just I also want to share like the the about Shalva point, like just having a place like this, an organization that you opened up, I think that was so much needed.

[00:49:07]Um and I'm so happy for all all all these people who struggle with this, who need a place to turn to, finally have a place where they can turn to for help where we have trained professionals uh with a lot of experience who know what to do and uh it's just amazing um what this does to the community. So Thank you so much. Thank you. Thank you for saying that. I want I want to point out that we're located in New Jersey, there's one other wonderful therapists and professionals who work with these issues in other areas. So, people don't live locally, they can definitely still reach out and we're happy to try to help people find the help that they need in a way that works.

[00:49:50]Okay, yeah.

[00:49:52]So, the one question that someone sent in just those sent in before, um my wife has pain and overall doesn't like intimacy, but she doesn't want to get help. What are my options? Right.

[00:50:10]You know, that's that's one of the toughest situations because, you know, if we're talking about creating safety and understanding in a relationship, um putting pressure on the spouse to do something that they don't want to do, um is probably not going to be helpful.

[00:50:28]And could actually backfire and make things worse.

[00:50:31]Um somebody in that situation um is must be feeling really, really stuck, really, really frustrated.

[00:50:41]And I wonder if there's some guilt also in there like we talked about that maybe I shouldn't be bothered by this and I should just not care so much.

[00:50:48]Um I would recommend that that person reach out to somebody who can give them some support and make them help them to feel like it makes sense that they're struggling so much with this.

[00:51:01]Um sometimes there can be ways where an individual can work with a professional or a mentor to help to to learn how they can relate to this topic in the relationship so that it makes the other spouse more open to exploring further.

[00:51:23]Very, very subtle and very, very gentle and you have to be very careful. Um but it is it that's a really, really tough situation to be in.

[00:51:32]Thank you.

[00:51:35]The next question is, what about men who experience this functional pain?

[00:51:40]Can you talk a little bit about pain for men? Sure. Um so, pain with men, as far as I understand and I've been, you know, really trying to learn as much about this as I can, pain with men seems to be less common than pain with women.

[00:51:54]Um sometimes when we have situations like that, it might be because, you know, there's a reason why men aren't reporting their experiences the same way women are.

[00:52:03]And so, I want to be careful not to dismiss it as if, you know, that's not something that happens. It certainly does happen.

[00:52:08]Um the first thing, just like, you know, with female pain, you want to get a medical checkup um with a doctor, with a a urologist to make sure that there's nothing physical that can be treated in a simpler way.

[00:52:22]Um there assuming that there is nothing wrong, then again, we'll start looking at the mind and the body just like uh just like with female pain, just like with that study that you mentioned. Um men, like we said, they have their feelings, they have their background, their experiences when it comes to intimacy.

[00:52:40]And could that be creating some sort of a a response of pain? Um certainly when it comes to other dysfunction, um erectile dysfunction, premature ejaculation, delayed ejaculation, these are things that have been studied well and the connection to what's happening in the mind during those experiences uh is well documented. And for that, there are medical interventions, there are also psychological intervention interventions, and certainly the relationship is central to that as well in my view.

[00:53:12]Um I guess just just quickly think about it if for whatever reason I have some negative experience with intimacy, um take for example if my wife has pain.

[00:53:22]So, she has pain, I don't want to hurt her. So, now I'm thinking about her feelings, thinking about trying to make sure that it's as, you know, as um as as as non-painful as possible. And now all of a sudden in my head I'm thinking and I'm rushing. So, our it it what's interesting is the body actually needs to be relaxed in order for it to function well in an intimate way. We need to allow feelings and sensations to overcome us, but if we're so in our heads about am I doing this right and is it going to hurt her, that can throw that can throw everything off line and can create dysfunction. Uh so, you know, those are all things that are are are good to know about and to explore such issues present. Right. And as I was saying this and all that, in general, uh couples that are struggling with um their sex life, um a lot of it could be related to like um having pressure of like um you know, are they are is their partner satisfied? So, as I was saying this like the a partner having pain is just a whole another layer, much more pressure um Pressure's a big deal. Yeah, which uh really um it creates uh issues um and and really interferes with the experience. Yeah, and some of these experiences with the men I will be addressed in future future future presentations down the road.

[00:54:47]Yeah, okay.

[00:54:49]If a couple has pain and relationship issues, how do they know where to start? Like, do they work on the relationship issues first? Do they try um, you know, focus on the pain first? Where do they start?

[00:55:04]Um good question. I think, you know, it depends on the extent of the relationship issues and the extent of the pain issues, too. But, you know, it really is individualized. You know, I think, you know, a a what's the mindset of the couple? Are are they both just really trying to, you know, move past this? Um and even if there's some other friction in the relationship, they're both committed to addressing the pain. So, okay, let's address the pain.

[00:55:29]You know, it really just depends on what the couple is presenting with.

[00:55:33]Certainly if there's intense relational issues, um and there's pain with intimacy, but intimacy is a fraught topic because of the emotional strain.

[00:55:42]So, we're not going to say, "Oh, let's fix the intimacy issues when, you know, there's not much of a relationship." So, it really is individualized and each couple has to be helped to understand where they're holding so that they can know the best place to start. Another thing I would throw out there is is like it's also depends a lot on, you know, where they are in the relationship. If this is a couple married for 3 months, it's going to be different than a couple who's been married for 3 years or 10 years. Um so, you know, an older couple has different things that then come into play biologically um as opposed to a younger couple. So, it really is nuanced and really has to be taken case by case.

[00:56:17]And I was asking that um is some pain normal?

[00:56:27]Hm.

[00:56:29]Okay, I want to answer this carefully. I I think the the takeaway answer should be no, there should not be pain. But, yes, at times there could be pain.

[00:56:40]Um Meaning that I the way I understood the question is, should people be like, "Oh, it's like if if the pain is not like crazy like to like we don't have to like seek out treatment. It's fine like Right. Let me let me Oh, no, I'm sorry to cut you off, but I realized I said something I really didn't want to say, which is that there could be pain sometimes.

[00:57:02]Pain is the wrong word. At times there could be some discomfort, especially in the beginning. And, you know, but the the expectation sometimes that like it's going to there's going to be agony and then it's going to go away.

[00:57:15]Um you know, I mean, what's that going to do to the nervous system to go into an experience with an expectation that you're going to be suffering in pain?

[00:57:22]So, you know, that No, even in the beginning, it shouldn't be pain. There could be some discomfort, there could be some sensation of pressure or stretching, something like that. Uh but but pain, the pain, no. No, it shouldn't be that.

[00:57:39]Is it possible for a person to develop pelvic pain several several years into the marriage? And does this also cause trauma?

[00:57:48]Um okay, so let's let's break it down into two parts. So, the first question of can you develop it later in marriage?

[00:57:54]Um the answer is yes.

[00:57:56]Um that would be considered secondary pelvic pain, meaning it's something that hasn't been with you all your life, it started up at a later time.

[00:58:04]Um when that happens, we get curious.

[00:58:07]What if anything changed around that time?

[00:58:11]What happened that may have changed the way that you associate with the experience? Did something change in your relationship? Did something change in your body? I think one thing that needs to be um explored is if a woman has children.

[00:58:26]So, the experience of pregnancy and childbirth and postpartum is I mean, they tell me, I don't know, but they say it's pretty difficult. So, it's that to just assume that, "Hey, I could go through that and then everything goes back to normal in mind and in body" is presumptuous. What if I had a really negative experience where I feel like what was supposed to happen with my birth didn't happen? What if I had some sort of an experience afterwards, after the birth in that area, that was deeply, deeply traumatic?

[00:58:58]Then that should just go away and I should just get back to the way things were?

[00:59:03]Hopefully yes, frequently yes, but very understandable if not.

[00:59:08]Um and so, you know, going through a history of the, you know, the time when the pain began, um even going back maybe even before that can help us to understand if there's uh you know, that emotional component there. Again, assuming that we've ruled out anything medical.

[00:59:24]Um what was the second part of the question?

[00:59:26]Um that does that cause trauma? You said something like that.

[00:59:32]Um I guess I'd be curious why the question is phrased that way.

[00:59:36]Um does it cause trauma? Um Maybe Maybe the the person um asking that question meant to be forward by trauma.

[00:59:48]Not sure. Um Okay. Yeah, I mean if whoever put that in the chat can clarify, that would be great. But I think certainly it can be caused by trauma, and that's one of the things that we look at in history if there's any traumatic experiences, whether it was a sexual trauma or some other body trauma or emotional trauma um that can be manifesting in this way.

[01:00:08]Um and I you know, I get I guess to answer the question, can it cause trauma? Technically, yes.

[01:00:14]Um but I think we want to be careful how we use the word trauma because sometimes that word comes up and it becomes this huge monster of now I have trauma, and it takes on a life of its own which by the way reinforces that sense that my body and this experience is not safe, which makes the brain does as to protect itself, which deepens the cycle, which creates the pain.

[01:00:33]So the language is important when we talk about, you know, anything related to this. But it certainly can it leave a lasting negative impression? Yeah, it can. And that's why it's so important to get help and to not continue living like that.

[01:00:46]Wow.

[01:00:47]Wow. So there are plenty more questions that we of course unfortunately will not get a chance to get to today.

[01:00:55]Um but we will send out uh um I'll We will send out a follow-up email um to all attendees and everyone who registered to you know, if you have any questions, there will there will be um contact information that you can send the questions to. Um and thank you so much for whoever did send in questions.

[01:01:21]Um Yeah, I see there's a comment here about some of the physical factors such as birth control hormones, medications that can impact um both the way the body is physically um uh the physical makeup of the body and the tissue um as well as emotional ramifications.

[01:01:41]Um so that's important also to know that that's a factor that we assess for and we look at.

[01:01:46]Great.

[01:01:47]Great. Great point.

[01:01:49]Um Um okay. So I know there there are more questions even that are coming in even as we speak. But since we are um I mean to you know, that's our timeline, we'll have to wrap it up.

[01:02:07]We will send out a follow-up email with contact information where you can send in your questions, and we'll try to get back to everyone.

[01:02:15]Um Please send them in. I'm happy to answer questions.

[01:02:18]>> Yeah. And we will also share uh more information about Shalva, about Revive and uh if you're watching this on YouTube, you can uh put your question in the comments, and we'll try to respond.

[01:02:32]Um once again, I want to thank you, Moshi, for taking your time and giving such an amazing presentation. It was very clear and very eye-opening for me um having not have had that much experience in physical pain and intimacy, so it was very eye-opening and very informative.

[01:02:52]And thank you so much for everyone who joined and took time out of their busy schedules.

[01:02:58]You have uh I'm assuming from the questions I see that we have some of you who are um joining for yourself, and some of you who are healers or kallah teachers or therapists.

[01:03:12]Um so thank you for the great work that you do.

[01:03:14]And um don't hesitate to reach out to either myself or Moshi um for any follow-up questions.

[01:03:25]And uh thank you so much for everyone's time.

[01:03:28]Thank you for having me on.