UUnniivveerrssiittyy ooff KKeennttuucckkyy UUKKnnoowwlleeddggee Pediatrics Faculty Publications Pediatrics 3-7-2006 CClliinniiccaall HHoolliissttiicc MMeeddiicciinnee:: HHoolliissttiicc SSeexxoollooggyy aanndd AAccuupprreessssuurree TThhrroouugghh tthhee VVaaggiinnaa ((HHiippppooccrraattiicc PPeellvviicc MMaassssaaggee)) Søren Ventegodt The Quality of Life Research Center, Denmark Birgitte Clausen Vejlby Lokalcenter, Denmark Hatim A. Omar University of Kentucky, [email protected] Joav Merrick Ben Gurion University, Israel Follow this and additional works at: https://uknowledge.uky.edu/pediatrics_facpub Part of the Pediatrics Commons RRiigghhtt cclliicckk ttoo ooppeenn aa ffeeeeddbbaacckk ffoorrmm iinn aa nneeww ttaabb ttoo lleett uuss kknnooww hhooww tthhiiss ddooccuummeenntt bbeenneefifittss yyoouu.. RReeppoossiittoorryy CCiittaattiioonn Ventegodt, Søren; Clausen, Birgitte; Omar, Hatim A.; and Merrick, Joav, "Clinical Holistic Medicine: Holistic Sexology and Acupressure Through the Vagina (Hippocratic Pelvic Massage)" (2006). Pediatrics Faculty Publications. 64. https://uknowledge.uky.edu/pediatrics_facpub/64 This Article is brought to you for free and open access by the Pediatrics at UKnowledge. It has been accepted for inclusion in Pediatrics Faculty Publications by an authorized administrator of UKnowledge. For more information, please contact [email protected]. CClliinniiccaall HHoolliissttiicc MMeeddiicciinnee:: HHoolliissttiicc SSeexxoollooggyy aanndd AAccuupprreessssuurree TThhrroouugghh tthhee VVaaggiinnaa ((HHiippppooccrraattiicc PPeellvviicc MMaassssaaggee)) Digital Object Identifier (DOI) http://dx.doi.org/10.1100/tsw.2006.337 NNootteess//CCiittaattiioonn IInnffoorrmmaattiioonn Published in The Scientific World Journal, v. 6, p. 2066-2079. Copyright © 2006 Søren Ventegodt et al. This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided that the original work is properly cited. This article is available at UKnowledge: https://uknowledge.uky.edu/pediatrics_facpub/64 Review Article TheScientificWorldJOURNAL (2006) 6, 2066–2079 TSW Holistic Health & Medicine ISSN 1537-744X; DOI 10.1100/tsw.2006.337 Clinical Holistic Medicine: Holistic Sexology and Acupressure Through the Vagina (Hippocratic Pelvic Massage) Søren Ventegodt1,2,3,4,*, Birgitte Clausen5, Hatim A. Omar6, and Joav Merrick7,8,9 1The Quality of Life Research Center, Teglgårdstræde 4-8, DK-1452 Copenhagen K, Denmark; 2Research Clinic for Holistic Medicine, and 3Nordic School of Holistic Medicine, Copenhagen, Denmark; 4The Scandinavian Foundation for Holistic Medicine, Sandvika, Norway; 5Vejlby Lokalcenter, Vejlby, Denmark; 6Section of Adolescent Medicine, University of Kentucky, Lexington; 7National Institute of Child Health and Human Development and 8Center for Multidisciplinary Research in Aging, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva and 9Office of the Medical Director, Division for Mental Retardation, Ministry of Social Affairs, Jerusalem, Israel E-mail: [email protected] Received April 27, 2005; Revised January 7, 2006; Accepted January 7, 2006; Published March 7, 2006 Many gynecological and sexological problems (like urine incontinence, chronic pelvic pains, vulvodynia, and lack of lust, excitement, and orgasm) are resistant to standard medical treatment. In our work at the Research Clinic for Holistic Medicine in Copenhagen, we have found that vaginal acupressure, or Hippocratic pelvic massage, can help some of these problems. Technically, it is a very simple procedure as it corresponds to the explorative phase of the standard pelvic examination, supplemented with the patient’s report on the feelings it provokes and the processing and integration of these feelings. Sometimes it can be very difficult to control the emotions released by the technique, i.e., regression to earlier traumas from childhood sexual abuse. This review discusses the theory behind vaginal acupressure, ethical aspects, and presentation of a case story. This procedure helped the patient to become present in her pelvis and to integrate old traumas with painful emotions. Holistic gynecology and sexology can help the patient to identify and let go of negative feelings, beliefs, and attitudes related to sex, gender, sexual organs, body, and soul at large. Shame, guilt, helplessness, fear, disgust, anxiety, anger, hatred, and other strong feelings are almost always an important part of a sexual or functional problem as these feelings are “held” by the tissue of the pelvis and sexual organs. Acupressure through the vagina/pelvic massage must be done with great care by an experienced physician, with a third person present, after obtaining consent and the necessary trust of the patient. It must be followed by conversational therapy and further holistic existential processing. KEYWORDS: quality of life, QOL, philosophy, human development, holistic medicine, holistic health, urine incontinence, vulvodynia, chronic pain, pain during intercourse, orgasmic potency, sexuality, ethics, vaginal acupressure, Denmark *Corresponding author. 2066 ©2006 with author. Published by TheScientificWorld, Ltd.; www.thescientificworld.com Ventegodt et al.:Clinical Holistic Medicine (34) TheScientificWorldJOURNAL (2006) 6, 2066–2079 INTRODUCTION Sexology is the medical specialty concerned with sexual dysfunctions. The major breakthrough in this field was made by Masters and Johnson in the middle of the last century, mapping the human sexual functions and dysfunctions[1,2]. William Howell Masters (1915–2001) was a gynecologist and Virginia Eshelman Johnson (1925–) a psychology researcher. They teamed up in 1957 to study human sexuality. Before them, in the late 1940s and early 1950s, Alfred C. Kinsey (1894–1956) had published two surveys of modern sexual behavior, “Sexual Behavior in the Human Male” and “Sexual Behavior in the Human Female”, which founded the groundwork for Masters and Johnson's work. Instead of asking people about their sexual activities, as Kinsey had done, Masters and Johnson observed sexual activity in the laboratory. They developed tools and techniques for accurately measuring the physical responses of 700 men and women during masturbation and intercourse. They published their findings in the book Human Sexual Response in 1966[1]. This book was well received by the general public, even though it was intended for the medical community, since the mechanics of sex had so far been a mystery. Masters and Johnson were the first to identify and describe the human sexual response cycle, which opened up the more effective treatment of sexual dysfunction and dissatisfaction with sexual activity presented as a natural and healthy human trait. Masters and Johnson afterwards published Human Sexual Inadequacy in 1970[2]. This book discussed common problems such as impotency and premature ejaculation, and how to treat them. This work was the key in the development of sex therapy and together they opened a clinic in St. Louis for the treatment of sexual problems. HOLISTIC SEXOLOGY The most profound theory for sexuality seems to be the theory of the anima and animus (the inner man or woman) of Carl Gustav Jung (1875–1961)[3,4]. Holistic sexology aims to take the established knowledge on sexology into an existential perspective, including the sphere of existential dimensions and problems[5,6] in the treatment of sexual and gynecological problems[7]. Existential dimensions are needed in this work because the sexual and gynecological problems are symptoms of unsolved existential problems, where the patient’s inner potentials for healing his/her own life, body, and existence are not mobilized. The reason that standard treatments do not work on some patients is not obvious. Often, there are hidden and severe traumas from violence or sexual abuse in the past, and these negative emotions are held by the pelvic tissues and organs. Studies from different western countries indicate an incidence of about 15% of girls being assaulted sexually in childhood[8,9,10] and many of these girls are likely to demonstrate severe pelvic problems in their youth. Sexual and gynecological problems resistant to standard therapy are typically problems with acceptance of own sex and sexuality, which do not have to originate from abuse. As originally suggested by Masters and Johnson, they can be a result of not having received the loving acceptance and touch needed in childhood[2,11]. It is obviously important that borders are not violated, but it is just as important that the father give the contact and acceptance the child needs as part of her infantile and undeveloped sexuality[7]. The Hippocratic (Hippocrates, 460–377 BCE) physician was aware of these diseases and his treatment included different physical procedures focused on the female pelvis, like smoking the vagina and massaging the pelvis[12]. The reason why these treatments were later condemned are debated; some authors find it a form of sexual abuse of the woman by the medical profession with an insufficient ethic[13]. Maybe there has been a regrettable crisis in the ethical standard of the average physician on entering modern-day commercial medicine, where power and money often seem more important for the physician than care for the patient. In holistic medicine, the physician and his/her patient are almost always very close and ethics are a subject of utmost importance (see the discussion). When it comes to the practice of pelvic massage, we might be at the essence of medical ethics and the ability to perform this 2067 Ventegodt et al.:Clinical Holistic Medicine (34) TheScientificWorldJOURNAL (2006) 6, 2066–2079 procedure might have been the very reason why Hippocrates invented his strict medical ethics in the first place. The traditional techniques of acupressure though the vagina has been tested and developed at the Research Clinic for Holistic Medicine in Copenhagen, and has been discussed with members of the International Society of Holistic Health and presented at the Second International Conference on Holistic Health, April 22–24, 2005 in Oslo (Sundvollen), Norway. The comments and critique have been integrated in the present paper. Many chronic patients need holistic existential healing or healing of the wholeness of the person on the deepest level of their existence in order to become better. Before we continue, therefore, let us take a look at holistic medicine and the concepts of existential healing. THE BASIS FOR CLINICAL HOLISTIC MEDICINE The life mission theory[5,11,14,15,16] is based on the philosophy that everyone has a purpose in life or talents. Happiness comes from living this purpose and succeeding in expressing the core talent in life. To do this, it is important to develop as a person into what is known as the natural condition or a condition where the person knows himself and uses all his efforts to achieve what is most important for him. The theory of talent[5] states that we have three major talents in life called purpose, consciousness, and gender. In relation to this paper, these dimensions may simply be love, power, and sex. Gender and sexuality are fundamental dimensions of human existence, which must be in a sound, natural, and undenied state for the person to live and function naturally and in full power. The holistic process theory of healing[18,19] and the related theories for salutogenesis[20,21], meaning of life[22], and quality of life[23,24,25] found that the return to the natural state of being is possible whenever the person gets the resources needed for existential healing. The resources needed are holding in the dimensions of awareness, respect, care, acknowledgment, and acceptance with support and processing in the dimensions of feeling, understanding, and letting go of negative attitudes and beliefs. The preconditions for holistic healing to take place are trust and the intention that the healing will take place. Existential healing is not a local healing of any tissue, but a healing of the wholeness of the person, making him much more resourceful, loving, and aware of himself, his own needs, and wishes. In letting go of negative attitudes and beliefs, the person returns to a more responsible existential position with an improved quality of life. The philosophical change taking place when the person is healing is often a change towards preferring difficult problems and challenges, instead of avoiding difficulties in life[26,27,28,29,30,31,32,33]. The person who becomes happier and more resourceful often also becomes more healthy, more talented, and more able to function[34,35,36]. Sexual problems are found in four major forms: lack of libido, lack of arousal and potency, pain and discomfort during intercourse, and lack of orgasm[2]. It is possible to work with a holistic approach to sexology in the clinic in order to find and repair the negative beliefs, repressions of love, and lack of purpose of life, which seemingly are the core to problems like arousal, potency, and pain with repression of gender and sexuality[2,6,7,37,38]. The theory of talent[5,6] seems to be relevant for understanding human sexuality. It is highly important not to focus on the gender and genitals in order to understand the patient’s sexual problems, because many problems related to sex can be solved on the level of the whole person[2,6,7,37,38]. But as important as it is not to focus there, it is also essential not to neglect the body and the feelings connected to it. Shame, guilt, helplessness, fear, and other strong feelings are almost always an important part of a sexual problem[2,7]. ACUPRESSURE THOUGH THE VAGINA Thousands of women have problems related to their pelvis and its organs, dominated by sufferings of the sexual organs, problems of the urinary tract, the locomotor system, and the intestines[39]. Another large 2068 Ventegodt et al.:Clinical Holistic Medicine (34) TheScientificWorldJOURNAL (2006) 6, 2066–2079 group of patients have “nonanatomic” pelvic pains and discomforts of presumably psychosomatic nature, which often are very difficult to treat with biomedicine, but which seem to react better to psychosomatic treatments[40,41]. We therefore urgently need new treatment tools for this broad range of problems, from urine incontinence, bleeding, and hormonal disturbances; unwanted childlessness; sexual problems like pain during intercourse; primary vulvodynia; or low ability to feel lust, pleasure, sexual excitement, and/or to reach sexual climax; to non-inflammatory perineal and anal pains and discomforts like idiopathic aches (primary pruritus). From a holistic medical perspective, the problems are often caused by unsolved emotional problems that have been repressed into the pelvis and its organs. The emotional problems are related to negative beliefs about self, gender, body, organs, and sexuality. Judging from clinical experience from the Research Clinic for Holistic Medicine in Copenhagen treating 20 patients with the 10 different problems mentioned above with holistic sexology (acceptance through touch and, when necessary, also vaginal acupressure), such problems can often be solved through healing the old wounds of the body and soul in holistic existential, gynecological, and sexological therapy. The healing process has, as in all other holistic therapy, three obligatory steps that we summarize with the words: feel, understand, and let go[18,19,42]. First the emotions have to be felt again; we call this phase “putting feelings onto the body”. Then the patient has to find words, i.e., verbalize the emotions and understand where the problems are coming from; we call this “putting words on the feelings”. Last but not the least, the person healing has to let go of the negative attitudes and decisions that were made when the trauma happened; we call this “putting consciousness in the words”. In the clinical work, we use the therapeutic staircase that gives us the best assurance that we do not use a more invasive and potentially dangerous technique than necessary[43]. Acupressure through the vagina always builds on earlier sessions of acceptance through touch, which again come after sessions of emotional healing, trust, and holding, and always begin with “love and care” for the patient. This staircase is also used at the Nordic School of Holistic Medicine for training the holistic physician to use the techniques from the holistic medical toolbox (see Fig. 1). FIGURE 1. The therapeutic staircase of holistic medicine[43]. In therapy, as well as in the training of the therapist, one step must be accomplished before the next step is used. Please take note that vaginal acupressure is a level-8 technique in this system. Level 8 is the most difficult level in the advanced holistic medical practice. Most holistic therapists work at level 3 and 4 and most problems related to health, quality of life, and ability can be solved at this level. 2069 Ventegodt et al.:Clinical Holistic Medicine (34) TheScientificWorldJOURNAL (2006) 6, 2066–2079 This knowledge of healing life (improving health, quality of life, and ability in one integrated movement) is well known and described in a number of books from the cradle of medical sciences on the island of Cos around 300 BCE, known as Corpus Hippocraticum. Hippocrates (460–377 BCE) was held to be the best physician of his time and father of the first scientific system of holistic healing described in numerous books. It is interesting that massaging the pelvis through its openings was an acknowledged method in ancient Greece[12] and in use throughout Europe for centuries[13]. This necessitated the very stringent medical ethics practice that was founded by Hippocrates probably, as mentioned above, with the purpose so that he himself and his many pupils could give this kind of treatment. Massage of the pelvic structures of a woman through the vagina and anus could, among other things, heal disturbances in the woman’s energy system known as a disease called “hysteria” from the Greek word for uterus, hystera. The treatment was in use in most of the western world until the industrial revolution, where it was condemned as pornographic and hence no longer an acceptable medical treatment. After the sexual revolution in the 1960s and 1970s, we now have a more relaxed attitude towards the body and sexuality, and some therapists work again with this kind of therapy through the vagina and anus either by using their hand to cure sexual and other problems[44], or by using a vibrant penis substitute (a “dildo”) to cure incontinence[45] or orgasmic problems[46]. The Danish physiotherapist Birgitte Bonde reports that one to six sessions with the vibrator can help many incontinent women who are not sufficiently helped by the standard program of training the pelvic floor[45]. The rationale for the use of the vibrator is that the woman cannot get in contact with their own pelvis, as they “cannot find their pelvic floor”, presumably because they have completely eradicated some of the pelvic structures from their inner description of their own body. There are several different forms of pelvic massage/vaginal acupressure (see Table 1) used for different purposes with as many philosophies about its mechanisms. Most therapists intend to raise the energies in the meridians found in the Chinese system[44], hence the name “vaginal acupressure” for the technique, often used for healing chronic pains in the pelvis or genitals, and treating the highly inconvenient pattern of frequent reinfection of the urinary system. Other therapists intentionally liberate the sexual energies with sexual stimulation, according to the old Indian Tantric tradition, in order to teach the woman to contain and handle her sexual energies[47]. We find it important to note here that the physician, under no circumstances, should attempt to stimulate the woman to an orgasm in order to avoid a sexual situation. Others work with confrontational therapy to heal traumas of incest and rape by integrating the bioenergetic system of Lowen[48], Reich’s sexual therapy[49], and the gestalt therapeutic tradition[50] to be able to release all negative emotions and other problems caused by the prior sexual violation or neglect. In our clinic in Copenhagen, we have also found it useful to help women heal what we call the “sex – love split”, making them having two partners, one for sex and one for love, and being unhappy with not being able to have love and sex with the same person. All the above-mentioned practices have in common that they seek to help the patient notice the tensions and blockages in the pelvic region, and the parallel attitudes fragmentizing the patient’s life. When the patients confront and integrate the repressed painful feelings that created them, they develop a new and more positive understanding of life, love, feelings, and sexuality. It is clear that elements of acupressure through the vagina must be adjusted to the needs of the patient. A patient with chronic bladder infection and a patient with chronic pain in the pelvis or the sexual organs (primary vulvodynia) should be treated differently. It is important to always go for the lesser level of treatment that can solve the problem and the least provocative or painful of methods must be tried before more “embarrassing” methods are taken into use. We recommend that simple antibiotics are used to alleviate some of the problem and only problems that cannot be efficiently treated with such drugs should be handled with the emotionally challenging procedure of acupressure through the vagina — except in the cases where the patient does not want to take the drugs for personal, political, religious, or other reasons. If the physician believes several methods to be equally efficient, he should always tell the patient about the alternative treatments and respect the patient’s choice. Holistic existential therapy will be more work for the physician and, in the end, less money paid by the patient as health problems are often solved permanently with holistic existential therapy. 2070 Ventegodt et al.:Clinical Holistic Medicine (34) TheScientificWorldJOURNAL (2006) 6, 2066–2079 TABLE 1 Different Forms of Traditional Pelvic Massage/Acupressure Through the Vagina Organized According to the Emotional Core Problems* Dominant Emotional Style of Work Corresponding Primary Inspiration Problem Chakra Anxiety, insecurity, Acupressure Root Chinese medicine Physical pain related through the to kidney and urinary vagina, pelvic massage Hippocratic med. tract and intestines Meridian work Root, All Incontinence, shame Use of vibrator Root, Hara Modern sexology Sexual and hormonal. Pelvic and anal Hara, Root Hippocratic medicine, Problems massage/ Indian tantric tradition, Pains during intercourse Chinese medicine acupressure Problems with lust, through the vagina joy, excitement, and and anus orgasm, shame Use of vibrator Hara, Root Modern sexology Low self esteem, Jung’s theory of Raising energy Hara, All anima and animus Polarity problems circles Sexual energy work Relational problems Pelvic and anal Solar plexus Hippocratic med. Problems with men after massage, acupressure Solar plexus, All Chinese medicine incest, rape and other through the vagina violations, hate, anger, and anus shame, guilt Controlled sexual abuse[43] Solar plexus Gestalt therapy Problems with integrating Pelvic and anal Heart, Root, Hara Hippocratic medicine Love and sexuality massage, acupressure Chinese medicine “Sex love split”, Adultery through the vagina Prostitution, Sexual Direct sexual stimulation[43] Hara, Heart, 3 eye Indian tantric tradition domination/submission Use of role-plays Heart, All Gestalt therapy *The therapy must always be followed by thorough conversational therapy for full integration and performance must be according to ethical standard (see text). Interestingly classical western medicine, Chinese medicine, and Indian medicine seem to have used related techniques. If a sexual problem can be solved with just giving acceptance to the body, there is no reason to approach the sexual organs. If just giving acceptance to the outside of the vulva is enough to solve the problem, there is no rationale for penetrating the vagina[7]. Often the feelings of guilt and shame that are the cause of the problem can be solved by the smaller process we call “acceptance through touch” and, in this case, it would be unethical to start with acupressure though the vagina. If conversational therapy can do the job, touching the vulva will be unethical. In every case, the physician must treat according to his or her best judgment. Medicine will always be an art and only the trained physician knows which tool to use with a patient as both intuition and experience is necessary for the decision. 2071 Ventegodt et al.:Clinical Holistic Medicine (34) TheScientificWorldJOURNAL (2006) 6, 2066–2079 THE PROCEDURE OF VAGINAL ACUPRESSURE Vaginal acupressure is technically the most simple procedure as it corresponds to the explorative phase of the classic pelvic examination, except that the purpose of the digital penetration is treatment and not examination. Vaginal acupressure is performed by placing the woman on the examining table in a relaxed position with free passage to the vagina (see Fig. 2). The physician penetrates the vagina with one or two fingers and presses systematically on the sore and tense areas in the pelvis. Most organs are accessible to the trained therapist. The position of the physician’s hand must be so that only the structures that need to be touched are contacted (it is important that the clitoris is not touched unintentionally). The applied pressure is adjusted to the situation to optimize the therapeutic effect, as described by Marion Rosen[51]. The indication for using this procedure in the holistic medical clinic must always be the physician’s understanding of the need of the patient for contact with the structures inside the pelvis. An attending nurse or another person must be present and give “holding” and support to the patient. FIGURE 2. Sexual healing though the vagina by pressing on the tissues and helping the patient to identify and process the repressed feelings and old traumas held by the pelvic organs[47]. The vagina is penetrated with one or two fingers, and all the structures of the pelvis are systematically worked through. The patient is invited to open up to the feelings hidden in the tissues and these feelings are then processed in holistic existential therapy. It is important to understand that the procedure of acupressure through the vagina is the same explorative part of the standard pelvic examination by a gynecologist, but in this case done so slowly that the woman can feel the emotions held by the different tissues contacted by the finger of the physician[38]. It can be used in combination with the pelvic examination and as the woman always will contact some feelings while examined in her vagina, the situation is really that every pelvic examination contains an element of acupressure through the vagina. Often the awakening of unpleasant feelings is very emotionally painful for the woman and if not taken care of by the physician/gynecologist, it will make the standard pelvic examination difficult for the woman, as many woman actually experience. Just ignoring the fact that the woman is a living human being reacting emotionally to the pelvic examination is not going to help the woman not to feel. 2072 Ventegodt et al.:Clinical Holistic Medicine (34) TheScientificWorldJOURNAL (2006) 6, 2066–2079 ETHICAL ASPECTS The procedure of acupressure through the vagina must be performed according to ethical standards. The holistic sexological procedures are derived from holistic existential therapy (which involves reparenting, massage and bodywork), conversational therapy, philosophical training, healing of existence during spontaneous regression to painful life events (gestalts), and close intimacy without any sexual involvement. In psychology, psychiatry, and existential psychotherapy[52,53], touch is often allowed, but a sufficient distance between therapist and client must always be kept, all clothes kept on, and it is even recommended that the first name is not taken into use to keep the relationship as formal and correct as possible[54]. The reason for this distance is to create a safety zone that removes the danger of psychotherapy leading to sexual involvement. In the original Hippocratic medicine[12], as well as in modern holistic existential therapy, such a safety zone is not possible because of the simultaneous work with all dimensions of existence, from therapeutic touch[55] of the physical body, feelings, and mind to sexuality and spirituality. Since Hippocrates, the fundamental rule has been that the physician must control his behavior, not to abuse his patient. The patients in holistic existential therapy and holistic sexology are often chronically ill and their situation often pretty hopeless, as many of them have been dysfunctional and incurable for many years or they are suffering from conditions for which there are no efficient biomedical cures. The primary purpose of holistic existential therapy is to improve quality of life; secondary, to improve health and ability. The severe conditions of the patients and the chronicity is what ethically justify the much more direct, intimate, and intense method of holistic existential therapy, which integrates many different therapeutic elements and works on many levels of the patient’s existence and personality at the same time. Holistic sexology is holistic existential therapy taken into the domain of sexology. The general ethical rule is that everything that does not harm and will help the patient in the end is allowed (“first do no harm”). An important aspect of the therapy is that the physician must be creative and, in practice, invent a new treatment for every patient as Yalom has suggested[52,53]. To perform the sexological technique of acupressure through the vagina, the holistic sexologist must be able to control not only his/her behavior, but also his sexual excitement to avoid any danger of the therapeutic session turning into sexual activity. Most physicians can do the classic pelvic examination after their standard university training, but the vaginal acupressure we are discussing here in this paper can only be obtained through long training and supervision in order to reach a level where such a procedure can be performed. Side effects of the treatment can be soreness of the genitals and periods of bad mood as old painful repressed material are slowly integrated. We have seen what we call an acute psychosis as a sexually abused woman confronted her most painful experiences, but she recovered in a few days without the use of drugs and this episode was an integral part of her healing. In fact, it was her therapeutic breakthrough. As it is possible that the patient can feel abused from transferences, it is extremely important to address this openly to prevent this situation. We recommend that the patient is contacted or followed up for 1–5 years to prevent and handle any potential long-term negative effects of the treatment. In spite of these problems, we have found the treatment with holistic existential therapy combined with the tool of vaginal acupressure to be very valuable for the patients. CASE STORY The following case story from the Research Clinic for Holistic Medicine in Copenhagen and also the case of Anna[56] made us reinvent the method of vaginal acupressure. This index case was a cancer patient who did not heal in the therapy, although level 1–7 of the therapeutic staircase (see Fig. 1)[43] had been taken into use for several months, so instead of giving up on her, we (SV and BC) reinvented the level-8 technique of acupressure through the vagina. The patient was part of our cancer project where we try to induce spontaneous remissions in metastatic cancer[57]. She had opted not to receive surgery, 2073