From Pain to Pleasure: Understanding and Healing Pelvic Pain
Pain during penetrative sex is more common than many people realize. Yet because it’s rarely talked about, 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 real, valid, and often treatable.
Healing works best with a team approach: medical care, pelvic floor physical therapy, and sex therapy all coming together to support your body, mind, and relationships. In this post, I’ll explain the role of sex therapy, and how it can complement 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 women describe it as sharp, burning, or pressure-like, and it may be worsened by certain movements, sitting positions, or when directly provoked during intercourse or when inserting a tampon. The discomfort can be felt deep within the pelvis, right at the vaginal entrance, or anywhere around or in between. Some common contributors include:
Medical conditions like endometriosis, vaginismus, vulvodynia, or interstitial cystitis
Postpartum healing, since childbirth can affect muscles, scar tissue, and pelvic floor function. Even months after delivery, people may experience discomfort with penetration, pelvic heaviness, or pain from scar tissue after a tear or C-section
Pelvic floor muscle tension or dysfunction, which can cause pain with penetration or even everyday activities like sitting
Hormonal changes from postpartum shifts, perimenopause, birth control, or certain medications
Stress and trauma, which can increase sensitivity and make your nervous system more reactive to pain
Gut issues, such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD), which can contribute to inflammation, pelvic floor tension, and pain in the pelvic region
The Role of Medical Providers
Gynecologists & Urologists can help identify or treat medical causes, prescribe medications, or suggest other next steps. It’s especially important to find a provider with training and experience in sexual health. Unfortunately, many women with pelvic pain have been dismissed or told “it’s all in their heads.” There is no shame in interviewing multiple providers until you find someone who listens, validates your concerns, and partners with you in care. While seeing a urologist may feel unrelated, many are actually at the forefront of sexual health research and specialize in pelvic pain, making them an important option to consider.
A wonderful resource for learning how to advocate for yourself in these situations is the book When Sex Hurts by Andrew Goldstein, Caroline F. Pukall, and Irwin Goldstein. It offers digestible explanations and guidance for navigating the medical system and getting the support you deserve.
Pelvic Floor Physical Therapists specialize in the muscles, nerves, and connective tissue that make up the pelvic floor. Through gentle manual therapy, guided exercises, and education, they help retrain your pelvic muscles in ways that minimize pain. Just like with doctors, the relationship you have with your PT is crucial. A good pelvic floor PT will make you feel safe, supported, and respected. They should always move at your pace, explain what they’re doing, and give you choices in your treatment. Feeling comfortable with them is not a “bonus” — it’s a key part of your healing process.
Both of these types of providers are essential pieces of the puzzle. However, pelvic pain doesn’t just affect the body; it touches emotions, identity, relationships, and confidence. That’s where sex therapy comes in.
How Sex Therapy Can Help
Rebuild Trust with Your Body
Pelvic pain can leave you bracing for discomfort before intimacy even begins. This anticipation creates tension, which can in turn make pain worse. In therapy, we work on tools to calm the nervous system, reduce anticipatory anxiety, and gently reintroduce safe, positive experiences of touch. Over time, you can learn to approach intimacy without fear.
Addressing Anxiety, Avoidance, and Shame
It’s completely natural to start avoiding intimacy when pain is involved. But avoidance can create a cycle: less sex leads to more anxiety and greater disconnection. In therapy, we explore these feelings with compassion: reducing shame, challenging unhelpful beliefs (“something must be wrong with me”), and helping you feel empowered to set boundaries that honor your comfort.
Supporting Communication with Your Partner
Partners often want to help but don’t know how. They may feel shut out, rejected, or even guilty. Sex therapy gives you both a place to practice honest communication, so you can talk about pain without blame and stay emotionally close. We also explore ways to nurture intimacy outside of penetration, so your romantic 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. Sex therapy can help you and your partner discover new, creative ways to connect physically and emotionally, focusing on pleasure, play, and closeness rather than performance or expectation.
Healing from Trauma or Past Negative Experiences
For some, pelvic pain may be connected to past trauma, or medical experiences that felt invasive or violating. Sex therapy provides a safe place to process these experiences at your own pace, and to explore how they may be impacting your relationship with your body today.
Collaborating with Your Care Team
Sex therapy doesn’t replace medical care or physical therapy — it complements them. I often collaborate with gynecologists, urologists, and pelvic floor PTs to ensure you’re supported from all angles. Together, we create a more holistic treatment plan, so your emotional healing goes hand in hand with your physical recovery.
Moving Toward Comfort and Connection
Healing from pelvic pain isn’t always linear, and it takes courage to seek support. But you don’t have to go through 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’re struggling with pelvic pain, reaching out is an important first step. Together, we can explore what healing might look like for you, at your own pace, in a way that honors both your body and your sexuality.
