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Clark Hemel is a New York City-based gender and LGBTQ + teacher who works primarily to help elementary school students discover their identities in a way that is safe, productive, and spiritually-enriching. Here, he talks to me, a good + good contributor and bizarre sex educator, about the intersection of eccentricity, pleasure, and pelvic-floor dysfunction.
Hamel and I are both part of the LGBTQ + community – I’m queer and bisexual and he’s a queer trans man – and we’ve both been diagnosed with a hypertonic pelvic floor. Also known as the overactive pelvic floor, the non-relaxing pelvic floor, and the tense pelvic floor, the hypertonic pelvic floor is marked by a condition where your pelvic floor does not relax completely or repeatedly – the hammock of the muscles that run back and forth. Side-to-side to support the pelvic organs – and affects an estimated 10 percent of people. The pelvic-floor muscles of those with this condition are all or often in a contracted position, which can present many symptoms.
Symptoms – such as difficulty emptying the bladder, constipation, pain when entering, cramps during core-intensity exercise, back and hip pain, heaviness of the pelvic floor, or otherwise – are often uncomfortable. And for many people, especially those within that diverse community, the situation can affect how they interact with their gender and sexual identity. This is definitely the case for Hamel and me.
Since receiving our respective diagnoses many years ago, we have each been relieved with the help of a pelvic-floor physical therapist. However, the situation is affecting our sense of identity. Next, we discuss our personal experiences undergoing diagnosis and treatment to shine a light on the under-explored intersection of queerness and pelvic-floor health.
Gabriel Castle: Clark! You and I have been following each other on Instagram for some time. But I didn’t start sharing my stories about my hypertonic pelvic floor that we actually connected.
Clark Hamel: Yes! I read a lot of articles from sources like WebMD and Mayo Clinic, but you are the first to see me talking about the condition as a person rather than a clinical sense. I’m so relieved that other people – especially other bizarre people – are experiencing this too.
GK: I know we’re both constantly working and navigating the intricate ways that the situation is linked to our queerness. In my case, until I started exploring my bisexuality, I didn’t know the fact that something was wrong with my pelvic floor. It was about 23 years old, after I identified myself as a lesbian, but then slept with Sis-Men. For the first time in my life, I was playing piercing games with phalluses much larger than a finger!
I was also in the process of becoming a certified sex educator at the time, so I knew P-in-V would often help reduce pain during admission: Lube, plenty of pre-play, trusted partner. But still, sex was incredibly painful. One day I learned about hypertonic pelvic floor because I was writing an article about pelvic-floor conditions, and immediately I liked, Oh i think this is me
Can you share a little bit about how you came to be diagnosed?
CH: Looking back, I have been experiencing symptoms associated with hypertonic pelvic floor for a long time. Orgasm was painful at times, and I was forced to urinate, but I thought everyone should do it. It was finally something else that led me to make a diagnosis.
One night, I was in the worst pain I had ever experienced; I didn’t know what was going on, but I knew my terrible stomach ache wasn’t right. I went to the ER and they did an internal ultrasound and found all this cystic fluid. The doctors in the emergency room told me to see a gynecologist. I shared that I am a transgender man, and that kind of care makes me deeply uncomfortable, but they recommended a bizarre- and transclusive provider. So, I went.
A few days later, the recommended gynecologist gave me an internal examination, and she was very calm the whole time. Later, we talked about cystic fluid, and she asked me if anyone had talked to me about my pelvic floor. They did not have.
She then explained how muscles work, why they are important, and told me that I suspect hypertonic pelvic floor. She asked if I had difficulty going to the bathroom, if there was tension in the area, or if I had problems with sex and access. Yes, yes, and yes. I put it all together – it was like, Oh my god i have it It was very eye-opening.
GK: And from there, the gynecologist recommended you to work with a pelvic-floor therapist?
CH: Yes Really, I was very resistant to go because I thought it was going to be a lot of internal research, which makes me uncomfortable as a trans man. I thought they would all be there, but it wasn’t.
GK: When I first started working with pelvic-floor therapists, I had the same preconceived notions about aggression. The day before my pelvic-floor exam, the office called and said, “Hey, I want to let you know that you need to wear gym clothes.” It scared me.
The appointment itself felt closer to a physical therapy appointment for a hamstring or funky ankle than a gynecological examination, which surprised me, where the pelvic floor is physically located. For the first 25 minutes of the appointment, the therapist watched me walk, touch my fingers, and walk through various stretches and weighted exercises.
As I have learned, the core muscles are a part of the pelvic-floor muscles, so the therapist was really interested to see how my core was involved – especially since as a crossfit athlete and coach, I was actively trying to engage my midline. I work for . When she saw me walking, she said she suspected me of having a hypertonic pelvic floor.
She said I could pass the internal examination if I wanted to, but she wanted to put on gloves and feel inside my vagina to understand what my muscles were doing internally. I agreed, so she licked her fingertips and then tried to squeeze and relax me against those inner muscles around her fingers. He realized that I could not, and after I received my official diagnosis.
CH: Even though I dropped out of the internal exam, I had a similar experience during my first appointment. We talked a lot about how the pelvic floor works. He described it in a way that allowed me to understand how interconnected all the muscles are.
GK: My biggest takeaway from my first appointment was that to start solving problems, I would normally have to lower my stress levels. Because, just like some people put tension in their snare or brace, I hold it on my pelvic floor. I’m really the kind of person, so this isn’t the first time a healthcare provider has asked me to work to manage my stress and anxiety. But it was also the first time I realized how important it was for my overall well-being.
CH: My therapist helped me learn how to do things I already do, such as urinating and having sex, in a more comfortable way. When I enter or sit down to urinate, I now practice breathing and relaxing for a moment.
She also suggested that I start working with vaginal dilators to learn how to relax around something on my pelvic floor. There were definitely a lot of clinical experiences using dilators, but it was a really important part of my recovery. It’s been four years since I was diagnosed, and it’s still important for me to include breathing and rest in my life.
GK: It’s been three years since I first received my diagnosis. And for the most part, I’ve managed the situation. My muscles are much more flexible and able to contract and relax than they used to. My diagnosis is the biggest way to identify myself in my life, the way it interferes and affects my bisexuality.
I’m attracted to people with all sex spectrum and different types of genitals, but if I’m sleeping with someone of the opposite sex who enjoys penetrative vaginal sex, it takes a lot more “preparation work” for me. Other forms of admission. So for me it’s an ever-present internal battle where I want to share, I want to enter and I want sex, but because of my pelvic floor, it’s much easier for me to have sex with people who don’t expect sex. Vaginal sex For example, a finger or toy is much smaller than a four, five, six, or seven inch long flush.
In my worst days, I have thoughts, Okay, so I’m bisexual … but is it worth it for me to have sex with a sex boss who wants to have sex with their penis in particular? I don’t think my pelvic floor problems change my sexuality, but it definitely changes my relationship. And it implies that I’m actively seeking partnerships.
CH: What you say means a lot. My diagnosis has definitely affected things around my penis.
For me, there is a present of shame associated with my diagnosis. For years before I was diagnosed, I essentially refused to use public bathrooms because I was trance and was afraid of having uncomfortable or unsafe encounters with strangers in public toilets. I put it in my urine A lot And it required a lot of use of my pelvic floor muscles. And that’s probably one of the reasons why I have to start over.
How does my condition affect my sex? I think the fact that I am trans makes potential partners think that I should never have P-in-V sex, or that I should be dysphoric about that part of my body. Often, people assume that penetrative games are not on the table.
But I really like my vagina and often like to include it in sex. So for me, having P-in-V sex and having fun is like acknowledging the fact that I like it emotionally, even though my shyness tells me “no” because I’m trans. It also means recognizing it Can Because of this pelvic-floor condition, I also have a little bit of physical difficulty.
GK: Nowadays, I have to give a lot of words to prove myself. Before many entering sexual encounters, I confirm in a loud voice: “I am bisexual! I am bisexual even in the days when certain types of sex are not on the table because I have a pelvic-floor condition.”
I think people experience queer impostor syndrome or dual impostor syndrome for a variety of reasons. And my pelvic-floor condition is just one of the reasons I experience this. By actively acknowledging my own sexuality, I am slowly learning to put those biphobic thoughts on their tracks.
CH: I like what you have to say about being able to confirm your sexuality for you. I try to do the same. And again, these would mean that you have to spend for these processes. Being a partner who, for many reasons, understands why penetrative sex can be uncomfortable and who is willing to help me breathe through experience so that we can both enjoy.
I have a lot of different sexes, so with new partners, I try my best to share with them what they need to know about my pelvic floor. For example, I might say something like, “You know, my pelvic floor is really tight, so be patient with me.”
GK: I like that degree of communication.
CH: It is always good to talk to you and connect with you on this subject.
GK: Similarly, Clark. Thanks!
The interview has been edited for length and clarity.
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