If you live in a body with two X chromosomes, you know intuitively that your pelvic and mental health are connected. When something’s off “down there,” it can throw off your mood or change the way you feel about yourself. The connection goes both ways, with your psychological state sometimes influencing your pelvic health, too. Here’s a deep dive into some of the ways mental, reproductive, and bladder health go hand in hand.
1. Bladder Problems and Emotional Distress
You know the feeling you get when you’ve really, really, really got to go, with no bathrooms in sight. Your palms get sweaty, you get a little bit shaky, and you might even start snapping at people around you. As the pressure in your bladder builds, so too do your levels of anxiety, irritability, frustration, and even anger. You develop a vague desire to cause physical harm to anyone walking slowly or blocking traffic ahead of you.
For people with overactive bladder, interstitial cystitis, incontinence, frequent UTIs, and other bladder disorders, that nightmare is a daily reality. You’re always in the bathroom, in search of a bathroom, and doing everything you can to avoid a public accident. You have to plan ahead, ditching or changing plans when they don’t include a nearby toilet. Over time, you can develop chronic stress, social anxiety, and reduced self-esteem.
While stress-reduction techniques can help, it’s usually best to combat the physical problem first. Treatments like UTI supplements can help defend against chronic UTIs, while more intractable bladder problems might require special treatment. Folks with interstitial cystitis might benefit from a treatment called instillation, where chemicals are injected into the bladder. Those with overactive bladder might benefit from special medications, surgery, or botox injections.
2. Chronic Pain, Trauma, and Mental Health
Any pelvic health condition that causes chronic pain can also impact a person’s mental health in a variety of ways. Even painful period cramps are enough to make a difference in your everyday mental state. People who suffer from conditions like endometriosis, fibroids, ovarian cysts, vulvodynia, and interstitial cystitis tend to suffer even more. In the long term, pain can lead to anxiety, depression, and other major mental health issues.
Some of the conditions that cause chronic pain can also require invasive testing, treatments, or surgeries. For example, in some bladder tests, a doctor inserts a catheter into the bladder and then fills it with liquid. A vaginal ultrasound, for cysts, requires a practitioner to insert a large probe into the vagina. The treatment for vulvodynia can involve inserting dilators into the vagina. Many conditions, like fibroids and cysts, ultimately require the sufferer to undergo surgery.
Along with these conditions and others comes a significant risk of medical trauma and, in some cases, PTSD. About 20% of patients who wind up receiving surgery will experience postoperative traumatic stress and/or PTSD. Poor treatment or a lack of medical consent can increase the risk of developing mental health symptoms. On the flip side, other types of trauma, like sexual or emotional trauma, can cause chronic pelvic pain and inflammation.
3. Hormonal Imbalances
A long list of hormonal imbalances and fluctuations can cause a longer list of mood changes and mental health symptoms. PMDD — a severe form of PMS — can cause irritability, anxiety, sadness, hopelessness, and depression. Menopause and perimenopause can cause similar symptoms, plus fatigue, sleep issues, forgetfulness or cognitive issues. Both PMDD and menopausal symptoms may be associated with suicidal ideation and, rarely, suicide attempts.
Other hormone-related pelvic conditions, like polycystic ovary syndrome, can cause significant mental health issues, like depression and anxiety. For a few weeks after childbirth, many new mothers experience “baby blues,” including mood swings and anxiety. In more serious cases, they may develop long-lasting postpartum depression, or even psychosis. The condition is probably caused by a sharp, sudden drop in hormones that occurs after delivery.
Hormone imbalances that cause mental health issues may be treated in a variety of different ways. Lines of treatment might include antidepressants, corrective hormonal medications, or different forms of talk therapy. Healthcare providers often recommend lifestyle changes to ease the symptoms of PMDD, postpartum depression, and other hormonal-pelvic conditions. A balanced diet may help, while a standard Western diet could worsen symptoms.
4. Sex, Body Image, and Self-Esteem
Pelvic health conditions that impact appearance or sexual function can result in feelings of low-self esteem, anxiety, inadequacy, and depression. For example, body changes after childbirth can change how a woman perceives and feels about her body. Vaginismus, dyspareunia, vaginal dryness, or pelvic prolapse can impact a woman’s body image, self-confidence, and more. Scars or other changes from pelvic or pelvic-related surgeries can also affect self-esteem and self-worth.
Ongoing pelvic health issues can also result in sexual dysfunction, causing pain or discomfort during intercourse or a lower sex drive. Over time, there’s a domino effect, as physical issues lead to more mental health issues. In turn, the emotional distress can lead to further pelvic floor dysfunction, causing a vicious cycle. In these cases, the sufferer usually needs a combination of therapy and medical treatment to find balance.
Unfortunately, people with these conditions may sometimes avoid seeking treatment or avoid other actions that could help. It can also be hard to find an understanding practitioner who is careful not to contribute to emotional distress. The wrong partner can worsen body image issues or sexual dysfunction, by contributing to feelings of unworthiness, pressure, or anxiety. In short, where sex and body image are involved, it can be a long road ahead to mental wellness.
Understanding the Link
These are just a handful of the ways in which pelvic health and mental wellbeing are inextricably interlinked. If you’re living in an AFAB body, your bladder and reproductive organs are bound to play with your moods at some point. Sure, modern medicine may help — it’s definitely come a long way since the days of hysteria stigmatization. However, a dearth of research means there’s still much more to learn about the mind-body-pelvis connection.