The Disruptive Discourse of Chronic Pelvic Pain

An academic article rather than a personal post, originally written in 2004 with a minor update to the Epilogue. This article explores how the structural framework of the doctor-patient relationship breaks down when women have unexplained Chronic Pelvic Pain (CPP), and explores some of the gender prejudices underlying this through a textual analysis of three books on chronic pelvic pain. These books were not specifically chosen for their gender prejudice; they were all I could find in the Bodleian Library on the subject of CPP in 2004.

Abstract

Chronic Pelvic Pain challenges the structural framework of pain, which both patient and doctor attempt to recuperate. Both patient and doctor rely on archetypal roles (the figure of the Doctor, the figure of the Woman), which need to be reconsidered for treatment to progress. The doctor's attempt to recuperate the framework relies on unsubstantiated psychogenic diagnoses and implicit blame, grounded in Freudian views of women; the patient's counterstroke is to withhold psychogenic information, including potentially valuable data on hormonal side-effects.  For treatment to progress and a successful framework to be recovered, both the patient and doctor roles need to be rethought.

Is this a beautiful shape?

Is this a beautiful shape? I could post this on Facebook and get the usual slew of obligatory compliments: "You look fantastic!" "Sooo beautiful!" "What a stunning bump!"  And so on.

Except I'm not pregnant. This isn't the elegant curve of a baby bump, it's the indistinguishable curve of endometriosis. It really is indistinguishable: when my endo's bad, I look so convincingly pregnant that I'm offered seats on buses, told off for drinking by strangers, congratulated by acquaintances. To add to the versimilitude, I often protect my stomach from painful knocks with a hand, exactly the sheltering gesture of a pregnant woman. Except I'm not pregnant.

Your stubbed toe still hurts

With the pain returning, I'm abruptly debilitated - unable to cook, clean, shop, barely able to walk. I'm reeling with the generosity and help of my friends. I idiotically put pine essential oil in a hot bath and ended up not with soothing heat for my swollen stomach, but burning all over, and too sore to shower or to wash the bath and start again. I bewailed my idiocy on Facebook - and a friend nipped over, made me tea, and cleaned my bath. Another friend messaged twice to ask what she could get me from the shops and went shopping for me. Another came to spend the afternoon with me and support my arm so I could have a short walk in the sun. And then, "I feel rougher than a badger's bottom," says a friend who's ill, "But I can't complain when you're suffering so much."

"I'm a bit... sore."

After a charmed two years without treatment and nothing worse than bad period pains and dyschezia, the pain is starting to return. Very slowly, imperceptibly, month by month. Is it  getting worse? And a few months later... It's definitely worse than last month.  And a month later... This is definitely worse. I call it subtle and imperceptible, but I've dropped to the floor in front of my partner when the pain attacked without warning and in privacy screamed out loud. I scrabble to put two coffees down as the pain starts, otherwise I'll drop them. I hate people knowing I'm in pain, but I have to tell my writing students, because I need to sit down while I explain something to them. And I realised, I say to people, "I'm a bit... sore."  But only me and my partner know what that actually means.

“I’m a bit… sore”

In chronic pain, you stop displaying
as you ought.
your nerves report: still the same
excruciating pain, again.

you ought to crumple, double, howl
but instead
your mind goes dead: a trial:
meanwhile, you stiffen, slightly, smile.

the pain will pass, or, it will last, and
all your will
can only still literal screams:
such pain long since exceeds your means

to respond, as you ought,
to what your nerves report