The Re-education of my perineum ~ one woman’s personal account

by faithgibson on August 31, 2013

The Re-education of My Perineum

By RUTH FOXE BLADER
 

Aude politely suggested that I insert the sonde, a tampon-like metal-and-plastic contraption with a long wire she would hook up to the computer. When I flinched, she reiterated the importance of perineal re-education. She delivered this practiced discourse with an air of utter professionalism, flicking through computer exercises with a mouse, her back pin straight. Thankfully. Because had she so much as cracked a smile, I wouldn’t have survived the ensuing psychic trauma.

I first encountered la rééducation périnéale four years ago when I was pregnant with twins and the slightly psychotic, very peremptory French midwife terminated what I presumed to be our final childbirth preparation session by correcting me: “No, you will see me again. After you give birth. For your perineal re-education.”

I muttered something like, “um, yeah,” then asked my ob-gyn what this was all about. “Don’t worry,” she told me, “it’s paid for by the state.”

That wasn’t my worry.

“It’s standard: to strengthen the pelvic floor so you don’t have urinary incontinence problems later in life,” she said.

She sounded so firm I knew it would be tough to weasel out of doing it.

“My perineum was never very well educated to begin with,” I told her. “We don’t do that in America.”

She looked at me hopelessly and sighed.

“After a twin pregnancy, it is a must.”

So, a couple of months after delivery, I was lying on my back in the midwife’s office, visualizing my poor, mangled perineum opening and closing like the doors of an elevator and squeezing in the shape of a snail shell. I guess the point of re-education of any kind is to rediscover “normal.”

Holding two newborns in my arms as a nurse wheeled the gurney down the hallway, I had felt anything but. Although I had resisted it, I consoled myself with the idea, however far-fetched, that gynecological muscle exercises would eventually deliver me from my new world of untold chaos.

Making disappointed faces, the midwife pronounced me weak. “You are so squeamish, we won’t use the sonde,” she announced. I was too terrified even to google it. But, after 10 sessions of her expert tutelage, I had regained the perineal competence to combat even the smallest drop of urine during the most allergic sneeze.

Four years later, I can say with confidence that the exercises, far more extensive than the standard Kegels that American gynecologists mention offhandedly, worked.

Unlike in the United States, where a hyper-medicalized pregnancy is followed by a perfunctory six-week follow-up, in France women aren’t left treading water in a sea of untold postnatal soreness. Many of my American friends have struggled with incontinence. But even a subsequent childbirth has failed to destroy my rock-hard perineum.

The French state has a stake in all this.

Preventive care represents a meaningful savings opportunity over a lifetime of health care costs, and the government is largely footing the bill. It is the reverse of our profit-driven medical system, where no one in the medical establishment has the incentive to save.

After giving birth the second time, I ditched the nasty midwife in favor of a friendly kinestherapeute, a multipurpose physical therapist widely employed by the French in the service of preventive medicine. This was Aude.

“When you push to urinate, you’re actually pushing your organs down, like squeezing a tube of toothpaste,” she said. “Like toothpaste, once it’s out, you can’t get it back in. Without surgery. We see women whose organs have fully descended.”

“Oh God!” I whispered, then, trying to act more French, cleared my throat, raised my eyebrows and murmured, “Ah bon?”

Still, I had no desire to insert the sonde. How did I know, for example, that it wasn’t a torture device? What if it malfunctioned and electrocuted me?

Aude was reassuring:

“It will be like playing Wii with your perineum.”

While doctors tout the incontinence cure and Aude talks of surgery for toothpaste tubes, the Frenchwomen I know consider the ultimate benefit of enduring this humiliation to be success in bed. After 10 sessions of perineal re-education, one is entitled to 10 sessions of abdominal re-education. Justement! A five-week vacation is always just around the bend.

When my husband probes for titillating details, I refuse to describe my sessions with Aude. If I were French, I would know my reticence as discretion, but I’m American so it’s actually just plain prudery.

Nonetheless, in a few weeks, when Aude debunks everything I ever knew about crunches in favor of sucking in my stomach while blocking my breath and opening my rib cage, I plan to comply. I’m going to be on time for my “relaxing” 10 sessions on abs. Maybe I’ll leave the 10th session with a six-pack. Prudery or no, I’m not one to spurn a re-educational opportunity.

Not a recidivist like me.

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