From Pain to Pleasure: Unpacking Pelvic Pain
Pain during penetrative sex is far more common than many people realize. Yet because it is rarely spoken about openly, it can feel deeply isolating. Many of the women I work with who experience pelvic pain describe feeling “broken,” or fearing that intimacy and pleasure will always be out of reach. The truth is, you are not alone—pelvic pain is very real and often treatable.
Healing is most effective when it takes a team-based approach: medical care, pelvic floor physical therapy, and sex therapy working together to support your body, mind, and relationships. In this post, I’ll focus on the role of sex therapy, and how it complements the care you receive from medical providers and pelvic floor specialists.
Why does pelvic pain happen?
Pelvic pain can have many different causes and ways of showing up. Some people describe it as sharp, burning, or pressure-like. It may worsen with certain movements, sitting positions, or when directly provoked during intercourse or tampon insertion. The discomfort can be felt deep within the pelvis, right at the vaginal entrance, or anywhere in between. Common contributors include:
Medical conditions such as endometriosis, vaginismus, vulvodynia, or interstitial cystitis
Postpartum changes, as childbirth can affect muscles, nerves, and scar tissue; discomfort with penetration, pelvic heaviness, or pain related to tears or C-sections can persist for months
Pelvic floor muscle tension or dysfunction, which can cause pain with penetration or even everyday activities like sitting
Hormonal shifts related to postpartum changes, perimenopause, birth control, or certain medications
Stress or past trauma, which can heighten nervous system sensitivity and amplify pain responses
Gut conditions, such as IBS or IBD, which can contribute to inflammation and pelvic floor tension
The role of medical providers
Gynecologists and urologists play a crucial role in identifying and treating medical contributors to pelvic pain. It’s especially important to find a provider with training and experience in sexual health. Unfortunately, many people with pelvic pain have been dismissed or told that “it’s all in their head.” There is no shame in seeking out multiple opinions until you find a clinician who listens carefully, validates your experience, and partners with you in care. Though seeing a urologist may feel unrelated, many specialize in pelvic and sexual pain and are often at the forefront of research in this area.
A helpful resource for learning how to advocate for yourself in medical settings is When Sex Hurts by Andrew Goldstein, Caroline F. Pukall, and Irwin Goldstein. It offers clear explanations and practical guidance for navigating care with confidence.
Pelvic floor physical therapists specialize in the muscles, nerves, and connective tissue of the pelvic floor. Through gentle manual therapy, targeted exercises, and education, they help retrain pelvic muscles to reduce pain and improve function. Just as with medical providers, the relationship with your PT matters. A skilled pelvic floor therapist will move at your pace, explain each step of treatment, and ensure you feel safe, respected, and in control. Comfort and trust are not extras—they are essential to healing.
While medical and physical care are vital, pelvic pain does not only affect the body; it also touches emotions, identity, relationships, and self-esteem. This is where sex therapy becomes an important part of the picture.
How sex therapy can help
Rebuilding trust with your body
Pelvic pain can lead you to brace for discomfort before intimacy even begins. That anticipation often creates muscle tension, which can increase pain. In therapy, we work with tools to calm the nervous system, reduce anxiety, and gradually reintroduce safe, positive experiences of touch. Over time, many people learn to approach intimacy with less fear and more confidence.
Addressing anxiety, avoidance, and shame
It is completely natural to avoid sex when it has been painful. But avoidance can create a difficult cycle: less intimacy leads to more anxiety and emotional distance. In therapy, we gently unpack these patterns—reducing shame, challenging unhelpful beliefs (“something must be wrong with me”), and helping you set boundaries that truly honor your comfort.
Supporting communication with your partner
Partners often want to help but don’t know how. They may feel worried, shut out, or even guilty. Sex therapy offers a space to practice honest, compassionate communication—so you can talk about pain without blame and stay emotionally connected. We also explore ways to maintain intimacy beyond penetration, so your relationship doesn’t have to feel “on hold” while you heal.
Expanding the definition of sex and intimacy
When pain is present, it’s easy to feel like sex is off the table. But intimacy doesn’t have to disappear. Therapy can help you and your partner discover new ways of connecting physically and emotionally, focusing on pleasure, play, and closeness rather than performance or expectation.
Processing trauma or difficult medical experiences
For some, pelvic pain is intertwined with past trauma or medical encounters that felt invasive or overwhelming. Sex therapy provides a safe, paced space to process these experiences and explore how they may be impacting your relationship with your body today.
Collaborating with your care team
Sex therapy does not replace medical care or physical therapy—it complements it. I often collaborate with gynecologists, urologists, and pelvic floor PTs to ensure you are supported from all angles. Together, we create a holistic treatment plan that aligns emotional healing with physical recovery.
Moving toward comfort and connection
Healing from pelvic pain is rarely linear, and seeking support takes courage. But you do not have to navigate it alone. With the right combination of care—from your doctor, your pelvic floor PT, and a sex therapist—it is possible to move toward intimacy that feels safe, pleasurable, and deeply connecting.
If you are struggling with pelvic pain, reaching out is an important first step. Together, we can explore what healing looks like for you, at your own pace, in a way that honors both your body and your sexuality.
