Sexual Guilt and CP/CPPS

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webslave
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Sexual Guilt and CP/CPPS

Post by webslave »

Can J Urol. 2016 Feb;23(1):8176-8.
'Spousal Revenge Syndrome'- description of a new chronic pelvic pain syndrome patient cohort.
Makovey I1, Dolinga R, Shoskes DA.

Psychological factors may play a role in the pathophysiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This case series describes a cohort of 10 men presenting with CP/CPPS whose symptoms began after an extramarital sexual encounter, who strongly believed they had a sexually transmitted infection (STI) despite negative testing, and who have had no improvement with empiric antibiotic treatment. Patients' clinical presentation and physical exam findings are reviewed. All men were clinically phenotyped with the UPOINT system. Pelvic floor spasm and not infection was prominent in these men. Treatment recommendations are proposed and compliance assessed.

PMID: 26892062
This is so true. We have several cases on this forum where this phenomenon is clearly on display, for example the guy who developed CPPS after a lap dance, even though he kept his clothes on, simply due to the panic and guilt over his actions.
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dshoskes
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Re: Sexual Guilt and CP/CPPS

Post by dshoskes »

This was one I was NOT going to call Shoskes syndrome.

One of my female Urology colleagues says she sees this in the spouses after the husband admits he cheated. Symptoms of STD in the spouse without cultures or antibiotics helping
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Re: Sexual Guilt and CP/CPPS

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I asked Dr Wise to comment on this.
Dr Wise wrote:Thanks for the Shoskes article. We wrote about this 10 years ago in our book A Headache in the Pelvis. We have seen many men like this over the years and offer both the psychological, physical and behavioral treatment that can help them out of pain. Here is the excerpt from our book:
Pelvic pain associated with a sexual encounter where no STD is present (from A Headache in the Pelvis)

There is a small but distinct group of men who complain of pelvic pain consistent with the typical diagnosis of prostatitis or chronic pelvic pain syndrome that arises after they have experienced a sexual encounter that they later regard with shame, guilt or regret. In this discussion, we will refer to guilty or anxiety sexual pain (GASP) from such an encounter.

Typically in this scenario, a man will pay a woman for a sexual massage or engage a prostitute for intercourse or will have a casual or long term affair outside of marriage or engage in some variety of sexual activity about which he retrospectively feels anxiety or guilt. Commonly, after the sexual encounter, the man fears that he has contracted an STD because of adverse symptoms. All appropriate tests are conducted and no STD is found. In the urological and psychological literature, there is little to explain the relationship between prostatitis/ CPPS symptoms, on the one hand, and the sexual behavior that is related to the symptoms.

Chronic prostatitis/chronic pelvic pain syndrome for a small number of male patients, is associated with sexual guilt or anxiety about a sexual encounter. We suggest here that men who report GASP-induced pelvic pain tend to share a common psychophysical response to their behavior that results in the perplexing symptoms of prostatitis/CPPS.

Psychophysical mechanism in GASP-induced pelvic pain/dysfunction

Contemporary urologic theory has been less than enthusiastic in implicating psychosocial factors in the onset of urologic disease. A mechanistic, body and organ centered explanation of the varieties of urologic pathology pervades the urologic literature. Here we are proposing a psychological theory of how psychosocial factors are intimately involved in the causation of symptoms of prostatitis/CPPS. We are suggesting that a person’s attitude and psychological viewpoint can result in a physical reaction in a man with GASP-induced pelvic pain/dysfunction. This man tends to operate with a rigid moral outlook. Events in life are black or white, right or wrong, good or bad. This moral standard is applied both to others and to himself. There is little room in the mind of these men for events, feelings and behaviors to be objectively viewed as they are, without a moral label. These men tend to disown feelings or behavior that they judge to be bad or wrong and regard themselves with contempt and rejection.

Men whose onset of pelvic pain occurs after a guiltily or anxiously perceived sexual encounter, tend to be hard-pressed to forgive feelings or behavior in themselves or others that they judge to be bad or wrong

Typically a man with GASP-induced pelvic pain views the sexual event retrospectively with remorse, guilt and fear of either having violated a moral code, being discovered by his partner or having contracted some kind of disease. When we questioned the men about the reasons for their behavior, there was little self-understanding about how they possibly allowed this sexual encounter to occur. When in a relationship, there tended to be no forgiveness of the circumstances and context in which such an event occurred (e.g., they were lonely, sexually frustrated, estranged from their partner and in need of some kind of relief, reassurance, self-esteem that was lacking, etc.). Instead, when asked about the behavior, the response of these men was that, “It was wrong and I shouldn’t have done it and I feel guilty and afraid because of it.” It is also not uncommon for them to say, “I probably deserve what I have.”

Men with GASP-induced pelvic pain/dysfunction give themselves little psychological space to have erred. We propose that their pain and dysfunction is the result of a twofold attempt to punish themselves and control themselves into refraining from such behavior in the future. They do this by tightening the muscles of the pelvic floor to stop the sexual feelings there from overwhelming them and causing them to lose control of their behavior.

Elsewhere we have discussed the theory that pelvic pain is the result of chronically pulling the tail between the legs, and is associated with fear, shame, remorse or guilt. It is not uncommon for a dog to pull his tail between his legs when his owner expresses upset over the dog’s behavior.

On a psychological level, men with pelvic pain associated with a sexual encounter would do well to ultimately forgive themselves and come to understand that they can control their sexual impulses without tightening the pelvis

In other words we are suggesting that the primary purpose of the response of these men to their own behavior that they reject in themselves is to chronically tighten their pelvic muscles as a way of stopping their sexual sensations in order to control their behavior. As in other men with muscle-related pelvic pain and dysfunction, this chronic tension and guarding creates an inhospitable environment in the pelvic floor that results in pelvic pain and dysfunction. In summary, guilt about sexual encounter leads to fear about self-control. Primitive response of fear and shame is for the man to “pull his tail between his legs.” This resultant unconscious prolonged tightening, is aimed at controlling sexual impulses and sexual acting out.

We treated an accountant with GASP-induced pelvic pain/dysfunction. He reported that during tax season, within a period of significantly increased stress in his life, and while at odds with his perfectionistic and judgmental wife, he had an affair with the secretary of one of his partners. He expressed great shame over his behavior as he considered himself a morally upright and religious man. He said that his moral values would never permit his infidelity but somehow he did it anyway. His affair went on for a little over a year. His wife discovered his infidelity and he went through a period of anguish with her. They sought counseling and he expressed his remorse repeatedly during their counseling sessions, promised never to do this again and begged his wife’s forgiveness.

Things more or less went back to normal in his relationship, however, it was at this time that his pelvic pain began. Initially when asked whether he had experienced any intimacy, stress reduction or beauty in his extramarital relationship, he could not find any value in it. He had difficulty focusing on the question of whether the affair served him in any way. He appeared not to want to appreciate what he got from the affair and instead repeatedly returned to his self-judgment and self-condemnation. Upon reflection, he reluctantly admitted that his extramarital affair brought him comfort, pleasure, self-esteem and stress reduction but quickly reiterated that these benefits could not justify his behavior. Shame and guilt in GASP-induced pelvic pain patients may be accompanied by the biological response to chronically pull the tail between the legs

He had great difficulty in conceiving that he could forgive himself for his behavior. When he was asked what he imagined would happen if he forgave himself for his infidelity, he answered that if he forgave himself he just might go back and do it again.

Men with GASP related pelvic pain we have seen tend to have difficulty in differentiating between thought, feelings, and behavior. When we proposed that it was possible to allow the experience of sexual feelings without acting on them, men with GASP related pelvic pain tended to be perplexed. How you allow impulses and emotions to be present while not acting on them was a strange concept to most of these men. And yet this distinction is a critical one in men with GASP induced pelvic pain to give themselves permission to relax their pelvic floor. The theory we speculate about this patient and others with GASP induced pelvic pain/dysfunction is that, in his shame and fear about his behavior, he pulled his tail between his legs continually and could not imagine stopping doing this. This chronic tightening of his pelvic muscles, was his way of ceasing to feel his sexual impulses. Not feeling his sexual impulses was his way of controlling them, thereby controlling acting on them.

The Wise-Anderson Protocol for GASP-induced pelvic pain/dysfunction: learning to control sexual impulses without chronically tightening the pelvic floor

We are proposing that there is a psychological requirement for a man with GASP-induced pelvic pain/ dysfunction wishing to overcome this pelvic pain and dysfunction. He would do well to forgive his behavior and come to understand that he can have a relaxed pelvis, feel sexual feelings and that he does not have to chronically tighten up his pelvic floor muscles in order to control his sexual impulses. He would probably help himself by coming to understand that a relaxed and uncontracted pelvic floor will necessarily open up the experience of sexual feelings and that these feelings are natural and need not be judged as wrong or bad in order to control acting on them.

Typically men with GASP-induced pelvic pain/dysfunction disown their experience as they consider it bad or wrong. This psychological disownment occurs simultaneously with the tightening of the muscles of the pelvic floor. When this disownment is added to an idea that their bad or wrong behavior should be punished as a way of controlling it in the future, they unconsciously tighten their pelvic floor even more. Once this period of chronic pelvic tightening occurs, as in other men with muscle-related pelvic pain, the condition takes on a life of its own. This condition is fed by the cycle of tension, anxiety, pain, and protective guarding. Added to that cycle, in these particular men, there is protective guarding against sexual feelings that arise in the pelvis.

In summary:
• Men with GASP-induced pelvic pain/dysfunction operate in a right-wrong world and judge what they perceive as their own morally wrong behavior with contempt and disownment.
• This disownment is both a psychological event of repudiation and judgment of their behavior and a physical event of implementing this disownment and repudiation by physically chronically tightening up the pelvic floor.

Treatment

Psychological treatment requires both the modification of the self-contempt and the thoughts that say, “The only way I can control myself is by tightening up my pelvic muscles as a way of controlling my sexual acting out.” The man has to feel that it is okay to have sexual feelings, that it is okay to have a loose pelvis and to experience sexual arousal, at the same time understanding that controlling sexual impulses can be done without killing the experience of the sexual impulses. It goes without saying that the full protocol we offer, including physical therapy and Paradoxical Relaxation, be an integral part of treatment.
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Re: Sexual Guilt and CP/CPPS

Post by dshoskes »

Should have published it then. When we would talk with infectious disease MD's who had patients like this and we would quote our anecdotal experience, they would always ask "is there evidence for this, is it in the literature"? It does matter.
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Re: Sexual Guilt and CP/CPPS

Post by Tetro »

You need trained sexologists to handle these matters, that's someone with a PhD in psychiatry/psychology and 4+ more years of training in human sexuality, along with experience in chronic pain syndromes. Most therapists go deer in the headlights when it comes to somatic dysfunctions related to guilt or trauma from sex.
Age:35 | Onset Age:19 | Symptoms: | Helped By: | Worsened By: | Other comments:
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