Understanding Pelvic Floor Pain and Dysfunction in Women
Pelvic floor pain and dysfunction in women is far more common than many people realise — yet it frequently goes unrecognised, minimised, or left untreated. Research suggests that up to 25% of healthy, non-pregnant women in the U.S. will experience some form of pelvic floor difficulty during their lifetime. In the U.K., the figure may be even higher, with up to 60% of women reporting at least one sign of pelvic floor strain or weakness, as reported by the Royal College of Obstetricians and Gynaecologists. These challenges can appear in many different ways — including pain or discomfort during sex, aching or pressure when sitting, frequent or urgent trips to the bathroom, or difficulty emptying the bladder fully. Left unaddressed, they can have a profound impact on day-to-day living, energy levels, intimate relationships, self-esteem, and overall wellbeing.
Vulvodynia, Vaginismus, Dyspareunia and Sex
Pelvic floor conditions such as vulvodynia, vaginismus, and dyspareunia (painful sex) can make intimacy and sexual connection extremely challenging for many women. Each involves discomfort or pain in the pelvic region, which may show up in different ways. For some, this means burning or stinging sensations from even the lightest touch — something as simple as wearing jeans, close-fitting underwear, or sitting for extended periods can trigger pain. For others, penetration during sex may feel impossible or unbearable.
“The pelvis is the cradle of life — when it holds pain, the whole body feels it; when it finds ease, the whole self can open.” — Anonymous
According to Stephanie Faubion, director of the Mayo Clinic’s Centre for Women’s Health, distressing sexual problems like these affect around 12% of adult women at some point in their lives. The impact often goes beyond the physical: women may struggle with arousal, experience a reduced sense of desire, or find achieving orgasm difficult or even impossible. Left unaddressed, these conditions can create ongoing frustration, emotional strain, and feelings of isolation. Unfortunately, because of the deeply personal nature of the symptoms, many women feel too embarrassed to discuss what they are experiencing. As a result, a large number do not seek medical or therapeutic help, sometimes living with these challenges silently for many years.
What Can You Do If You Have Pelvic Floor Pain and Dysfunction?
If you are experiencing pelvic floor pain or dysfunction, the first and most important step is to seek a professional assessment. Scheduling a physical examination with a sexual health specialist or gynaecologist can help identify whether there is an underlying medical condition contributing to your symptoms. This may include checking for hormonal imbalances, nerve-related issues, infections, or gynaecological conditions such as endometriosis or fibroids. Identifying and treating any physical cause can often provide significant relief.
However, in many cases no obvious medical explanation is found, and this does not mean the pain is “imagined” or any less real. Rather, it highlights the complex interplay between the body and mind. When structural or hormonal issues are ruled out, it is useful to explore other influences such as psychological, emotional, social, and even cultural factors. Stress, unresolved trauma, relationship challenges, or negative beliefs about sexuality can all contribute to how the pelvic floor muscles respond, often creating patterns of tension and discomfort. Recognising these wider influences is an essential part of finding an effective and holistic approach to healing.
How Can Somatic Sex Therapy Help?
From a somatic sex therapy perspective (also known as tantric healing), healing pelvic floor pain means looking beyond symptoms to address the whole person. This approach recognises that the pelvic floor does not function in isolation, but is deeply connected to emotional wellbeing, past experiences, and a person’s overall sense of safety in their body. Treatment therefore extends beyond simply working with the tissues or teaching the muscles to relax. It involves exploring the deeper reasons why the muscles may be chronically tense and how both the body and mind can learn to let go of that tension.
Many holding patterns in the pelvic floor develop as a protective response. When someone does not feel safe — whether because of unresolved trauma, ongoing stress, or even subtle patterns of fear or shame — the body often contracts as a way of guarding itself. Over time, this unconscious tightening can create pain, discomfort, or dysfunction. Somatic sex therapy provides a safe, supportive space to gently unwind these patterns, helping clients reconnect with their bodies, build trust in their own sensations, and cultivate a sense of relaxation and safety. By integrating awareness, touch, breath, and dialogue, therapy can address not only the muscular aspect of pelvic floor tension, but also the psychological and emotional layers that sustain it. This is closely connected with the practice of de-armouring, which supports the release of long-held patterns of tension and protection in both body and mind.
“The ability to feel relaxed in one’s body requires the emotional experience of safety” [Bessel van der Kolk]
What Role Do the Brain and Nervous System Play in Pelvic Floor Pain?
The pelvic floor muscles are highly responsive to the state of the brain and nervous system. When we experience anxiety, fear, or stress, the body often reacts automatically by tightening these muscles, even if we are not consciously aware of it. This protective response is not limited to women who have a history of sexual abuse or trauma; it can also occur in those who have absorbed messages of shame, guilt, or negativity around sexuality and the pelvic area more generally.
Tension can also arise in completely non-sexual contexts. Everyday stressors — such as having an argument, facing work deadlines, or simply feeling unsafe in an environment — can cause the pelvic floor to contract. Once this muscular holding pattern develops, it can trigger a feedback loop: the tight muscles send signals of threat to the brain, and in turn the brain interprets this as potential danger. The nervous system, which plays a central role in somatic therapy, may then amplify sensations in the pelvic region, sending pain signals to the tissues even when there is no physical injury. This creates a cycle of fear, tension, and pain that can feel very difficult to break.
Understanding this mind-body connection is essential in treatment, because it highlights why pelvic floor pain is not “just in the body” or “just in the mind,” but a complex interaction between the two. Approaches that calm the nervous system — such as breathwork, grounding practices, or trauma-informed somatic therapy — can help interrupt this cycle and support the body in returning to a state of safety and relaxation.
Breaking Out of the Vicious Cycle
The encouraging news is that it is possible to break out of the cycle of fear, pain, and tension. With the right support, many women learn to relax the pelvic floor and feel safe enough not only to tolerate, but eventually to enjoy receiving touch again. Thanks to the brain’s neuroplasticity — its natural ability to form new pathways and responses — change is possible even after years of repeating the same patterns. Brain cells, or neurons, renew and adapt regularly, which means they can be “re-trained” to respond in more supportive ways.
One effective approach is to work with the body directly, gradually teaching the pelvic tissues that touch can be safe. Gentle bodywork techniques help the nervous system relax and begin to release long-held tension. Graded motor imagery and similar methods are also useful for working with chronic pain, as they build new, more positive associations with movement and touch.
“When we listen to the body with compassion, even pain becomes a teacher guiding us back to balance.” — Marion Woodman
Modern pain science has shown that pain is generated by the brain rather than by the tissues themselves. This means it is crucial to teach the brain to send fewer pain signals. Visualisation can be a powerful tool here: imagining touch or movement while in a calm state helps the nervous system learn safety, even before direct contact takes place. For some women, using dilators — starting with the smallest size and increasing gradually — provides a structured way to desensitise and rebuild comfort with penetration.
When dilators feel overwhelming, visualisation alone can still create change. Simply imagining gentle touch while remaining relaxed can teach the brain that the activity is not threatening. In many cases, pelvic pain develops because the brain has become over-sensitised to danger signals. Learning how to calm these signals — through safe touch, visualisation, and nervous-system regulation practices — is a key step in reducing both tension and pain.
Opening Back Up to Intimacy
When pelvic pain or discomfort becomes ongoing, many women understandably begin to withdraw from intimacy altogether. In order to avoid painful experiences, they may choose to avoid not only penetrative sex, but sometimes even affectionate touch, fearing that a simple hug or a hand on the arm might be interpreted as an invitation for more. Over time, this protective strategy can create distance in relationships and reinforce feelings of isolation.
A gentle and effective way to rebuild comfort is through sensate focus, a technique that encourages partners to explore non-sexual touch without pressure or expectation. By shifting the focus away from the genitals and away from the idea that touch must lead to intercourse, the experience becomes safer for the nervous system. This gradual approach allows the body and mind to rediscover touch as nurturing, pleasurable, and free of demands.
As confidence grows, tolerance for different kinds of touch can be increased step by step, always at a pace that feels manageable. Importantly, removing the goal of orgasm or intercourse reduces performance pressure and makes space for genuine enjoyment of sensations in the moment. Alongside this, working with unhelpful beliefs — such as “this will never change” or “the pain will only get worse” — is crucial. Replacing these with hope and trust in the body’s ability to heal is a key part of the therapeutic process.
Further Information
Pelvic floor pain, tension, and dysfunction can have a profound impact on daily life, intimacy, and overall wellbeing — but with the right support, healing is possible. Approaches such as pelvic floor therapy, somatic sex therapy, and nervous system regulation can help release holding patterns, reduce discomfort, and rebuild confidence in your body.
Pelvic floor pain and dysfunction are not signs of failure or brokenness, but often reflect patterns of protection held in the body and nervous system. Somatic sex therapy, sometimes described as tantric healing, offers a gentle and trauma-informed approach to working with pain, tension, and fear by restoring a sense of safety, awareness, and choice in the body.
If this article resonates, you may wish to explore Somatic Sex Therapy as a supportive pathway for easing pelvic pain, rebuilding trust in your body, and gradually reconnecting with intimacy at a pace that feels right for you.
Updated January 2026