The National Council of Psychotherapists
Hypnosis in obstetrics, gynaecology and genito-urinary conditions
Some considerations and examples
Asaf Rolef Ben-Shahar
Sexual development, pregnancy and menstruation are frequently wrapped up with guilt, shame, fears and anxieties. High percentage of gynaecological problems have a strong psychosomatic or psychogynecic influence. Since we so frequently use our body as metaphors (body-talks), it is no wonder that so many fears manifest in areas, which carry intense emotions.
Similar to gynaecological and obstetrics problems, genitals and bladder problems often carry a significant psychological factor – if not in their aetiology then at least in the prognosis of the condition. Unhealthy shame, guilt and fear represent attitudes to self, sexuality and emotions, which frequently manifest in bodily symptoms – and the pelvic region is particularly sensitive to such attitudes.
Hypnotherapy can be used for dealing with the underlying emotional stresses and fears (explorative work, understanding the psychodynamics of symptoms), but also for symptom removal. The use of self-hypnosis has proved valuable in numerous cases.
Kroger (1977) describes utilization of hypnosis for menstruation management (including bleeding, helping amenorrhea by rehearsal or age regression, working with menopause etc.), with the sexual and developmental issues that sometimes manifest bodily and more. I have found that ‘parts therapy’ is particularly useful in helping people with psychosexual problems, for both men and women. So many psychosexual disorders have potent secondary gains, which take years to realize in psychotherapy (and frequently, even when realized no shift occurs). Hypnotherapy can be an extremely potent tool.
In this paper I shall give some clinical examples for the use of hypnotherapy in gynaecology, genito-urinary and obstetrics. These are examples of short-term and goal-oriented processes, which do not necessarily reflect the majority of my therapeutic processes and interventions, but are convenient to use for the purpose of this paper,
A. Finding the joy of sex again:
After many years of sexually abusive relationship, Deirdre has finally left her husband. When she started dating another man, she realized she was unable to orgasm, or at all be physically aroused. “I fear,” said Deirdre, “that I am no longer capable of enjoying sex.” Having worked with her for a long time, and having good rapport, it took a single session to change it. I have used reimprinting technique (working with timeline) to bring forward an old resource, and left Deirdre in the room by herself for twenty minutes, to rehearse ‘the best sexual experience you have had in your entire life.’ When I returned, Deirdre was blushed and pleased. Sex-life became an arena for development and exploration for her.
B. What would allow you to be pregnant?
Su sought help because she wanted to get pregnant but couldn’t. She also had flying phobia. These prevented her from pursuing dreams of having a family and travelling around the world. During the interview, Su talked about her fears of vomiting (which was common to both). Using age-regression as an uncovering technique, and VK dissociation to progress from that time, a strong shift occurred. After two sessions Su bought tickets to fly away, and three months later she became pregnant.
As discussed earlier, psychosomatic factors contribute to many of the male and female infertility problems. Since hypnosis can shift emotional states and also effect physiological processes, it opens the door for effective interventions. Hypnosis was used to help with many conditions, including increasing sperm-count or sperm motility. Relaxation, freedom from anxiety and changing attitudes are also helpful. As Erickson has demonstrated with the ‘psychological shock’ administered to a prude couple (go fuck for fun), hypnotic communication can prove a powerful tool for reframing sexual difficulties. Erickson (1958) wrote: “I wouldn’t try use hypnosis to correct the impotence or the frigidity, because both impotence and frigidity are rather deeply involved problems employing faulty attitudes toward the body, faulty orientations towards the body, and a lot of confused understanding on the subject of sex and emotion in general. Therefore, I would use the hypnosis for the purpose of providing a different psychological orientation.”
C. Unsuccessful attempt to work with physiological symptom:
Vulvar vestibulitis is one type of vulvodynia that is characterized by painful tender areas at the entrance to the vagina, the vestibule. These areas have been found to be non-specifically inflamed on biopsy (Oakley & Ngan, 1999-2003). Laurie was a young woman of twenty-five, who couldn’t have sex with her boyfriend because of the painful vagina. She tried everything, but neither allopathic medicine nor alternative solutions helped.
We have used some simple pain-management techniques, which were quite successful – and Laurie managed to monitor the pain, and learned to relax her muscles, allowing for normal blood flow. The results, however, were temporary. When we started working more deeply with the meaning of the symptom, Laurie has experienced a total but temporary remission. She suddenly had a change of heart about therapy, and was reluctant to continue working, as she thought that trying to look at the psychological or emotional components was unreasonable.
D. The advantage of military discipline in sex:
It is thought that over 90% of sexual difficulties are psychosexual. Premature ejaculation and impotence are among the most common conditions. These problems tend to participate in a vicious circle of loss-of-confidence, anger, frustration and embarrassment – and stress, which increase likelihood of reoccurrence. As Kroger (1977) notes, most psychosexual problems stem from lacking communication skills. He writes: “Many men are totally incapable of love in a mature sense”.
Hypnotic treatment of premature ejaculation and impotence may focus on the emotional element by reducing anxiety, or exploring symptom’s meaning. Time-distortion, age-progression and symptom-transformation (worrying about inability to ejaculate…) have all been tried.
I am reminded of an old client of mine, who returned to see me after two years (he initially came for something totally different). Doron, 45 years-old ex-military man, complained about premature ejaculation. During our work together in the past, Doron’s metaphor for ‘controlling his anger’ was that of an army General – he had gathered his troops and soldiers: they were indeed ready, but only he could give them the command to raid. Back then; Doron took great pleasure in his monitored power. We have chatted, seemingly on unrelated subjects when Doron developed a nice trance. I only said two sentences: “Man, we’ve been through some crazy times together, isn’t it good to know you can hold your soldiers back so well.” Doron stayed in trance for ten minutes and walked out. He found that he could have intercourse without coming too soon.
E. Natural Birth:
I helped Claire (35) prepare for her second birth. Claire decided to give birth naturally at home. She had a supportive team of a midwife, homeopath and her husband. Outside, an ambulance would wait in case medical care should be needed. Her first birth was also homebirth but she was in so much pain that Claire could not enjoy the process, or meet with her son and had suffered post-natal depression.
I have seen Claire for a few months, firstly on her own and later with her partner, and taught her self-hypnosis.
Although Kroger (1977) states that Hypnoanesthesia per-se can only be effective with 20 percent of the population, I believe that with adequate training – and flexible communication – these figures could be significantly higher. Notwithstanding this theoretical observation, Claire learned how to apply glove-anaesthesia and symptom transformation quickly. She considered the 5% chance of confusing pain with sexual arousal, and learned to perceive pain differently. Additionally, Claire learned various breathing and relaxation – imagery techniques. Using age-progression (pseudo-orientation in time), Claire had given the ‘past-self’ (and me) advice as to the necessary preparation for successful pain-free birth. She rehearsed the birth numerous times. The last three sessions were conducted at Claire’s home, with her husband and child present (and so much noise), and both rehearsal and analgesia were carried-out. Her partner learned to help Claire with her anchoring and suggestive work.
I was excited towards the prospect of being present at her labour, but as we came closer to her due-date, Claire became so proficient in the use of hypnosis, dissociation and pain-management, that it was clear I wasn’t needed. Despite my slight disappointed, I was delighted to hear that Claire’s birth took less than three hours and she had no need for drugs. She described her birth as a spiritual and peak-experience, and recovered her strength amazingly quickly.
Kroger emphasizes the need to discuss the misconceptions of hypnosis beforehand, as well as checking for the woman’s rationale for seeking hypno-birth (to confirm reasonable expectations, and freedom from neurotic-desires present). He further reiterates the need to inform patients of the availability of drugs, if needed. It is important, he writes, that the woman doesn’t try to ‘do it for the therapist’, and that no expectations should be made of having to only use hypnosis (ibid).
Hypnosis can be used in other areas of obstetrics. These include supporting symptoms during pregnancy, such as nausea and vomiting; treating emotional and physiological factors in ‘abortion habits’ and recovery from miscarriages.
Erickson, M.H. (1958), Utilizing Natural Life Experienced for Creative Problem Solving, in Rossi E.L & Ryan, M.O. (Eds). (1985), The Seminars, Workshops and Lectures of Milton H Erickson, Volume II - Life reframing in Hypnosis, London: Free Association Books, 125.
Kroger, W.S. (1977). Clinical and Experimental Hypnosis, 2nd Edition. Philadelphia: Lippincott Williams & Wilkins.
Oakley, A. and Ngan, V (1999-2003). Vulvar vestibulitis. New-Zealand Dermatological Society. Retrieved February 27 2004 from: http://www.dermnetnz.org/index.html
Asaf Rolef Ben-Shahar
London: Bliss, 333 Portobello Road, W10 5SA Tel: 020 8969 3331
St. Albans: The Bassett Clinic, Aberfoyle House, Stapley Road, Herts AL3 5EP