Therapy for Pelvic Pain Isn't a Last Resort (Even If No One Told You That)
By the time most people find their way to me, they've already been through years of doctors, treatments, anguish and self-doubt. They may have tried the cream, the pelvic floor work, maybe a procedure. Many have been told everything looks normal, and have felt dismissed. (If you've heard "everything looks fine" while actively being in pain, you know how maddening that is.)
Somewhere along the way, a lot of them started to quietly believe there's something wrong with them — not just their body, but them as a person. That belief is heavy, and it's one of the hardest parts of chronic pelvic pain to undo, because by the time we start working together, it's had years to settle in.
And this isn't just what I see in my practice — the research backs it up. A recent study of women with painful sex found that half had never even undergone a formal diagnostic process, and the responses they got from providers ranged from unhelpful to outright dismissive. Only a quarter had ever seen a psychologist, and half didn't know pelvic floor physical therapy existed as an option. The authors concluded that the care these women received was "often insufficient and not aligned with a biopsychosocial model" (Wojtas et al., 2026). If that resonates with your experience, you're not imagining it, the system really does underserve people with pelvic pain.
Here's what I want you to know if you're newly diagnosed, or still trying to figure out what's going on: you don't have to wait until you've "tried everything" to bring a pelvic pain psychologist into your care team. In fact, the research says the earlier, the better.
Table of Contents:
Is My Pelvic Pain All in My Head?
No. Chronic pelvic pain conditions like vulvodynia and vaginismus involve real, measurable changes in how your nervous system processes signals from your body. Your nerves and muscles essentially learn the pain pattern and get better (worse) at producing it over time.
Thanks, nervous system!
That's not imagined, and it's not a character flaw or a problem with how you coped. It also means the nervous system that learned this pattern can be part of how you unlearn it, which is exactly where therapy comes in — alongside your gynecologist and pelvic floor physical therapist (PT), not instead of them.
I say this a lot to my patients: using therapy to help with pain doesn't mean the pain isn't real. It means the mind-body connection is real, and we can use it as a tool to alleviate pain.
Why Hasn't Anything Worked Yet?
Pelvic pain is multifactorial. It is kept going by more than one thing at once, which usually includes some combination of nerve sensitivity, pelvic floor muscle tension, inflammation, and the psychological weight of fear and hypervigilance around pain.
When treatment only addresses one piece — say, a topical medication, or a few rounds of PT — it can genuinely help, but only partially. And partial relief, without an explanation for why the rest of the pain is still there, is its own kind of exhausting. It's what leads so many people to conclude "I've tried everything" when really, they've tried pieces of a puzzle without ever seeing the full picture.
Layered on top of that is the emotional burden of the journey itself — appointments where you had to describe intimate pain to strangers, providers who didn't fully believe you, medical staff that were not trained in pelvic pain and were not gentle, and the slow accumulation of feeling broken. None of that is just 'in your head.' It's part of what keeps pelvic pain going, and it's exactly what therapy is designed to address, ideally before it ever gets a hold of you.
Is Seeing a Pelvic Pain Psychologist Only for People Who've Tried Everything Else?
No — and this is the part I most want people to hear. An expert panel convened through the International Consultation on Sexual Medicine identified psychological intervention as one of the primary recommended treatments for vulvodynia, alongside pelvic floor physical therapy — not a fallback option for when those don't work (Goldstein et al., 2016).
Clinical trials have followed the same logic: guided psychological treatment (using cognitive behavioral and acceptance-based approaches) has shown measurable improvement in pain and in patients' ability to engage in intimacy again, even when delivered during the waiting period before other treatment starts (Engström et al., 2021). Psych isn't the consolation prize you get after everything else fails. (Though I understand why it can feel that way when it's the last thing anyone mentions.) It's one of the three legs of the stool, recommended from the start because it has some of the strongest evidence behind it.
What's the Difference Between Pelvic Floor PT and Pelvic Pain Therapy?
Your pelvic floor PT works with the muscles, tissue, and physical mechanics of your pelvis, teaching your body to release tension, retrain reflexive clenching, and rebuild tolerance to touch and movement.
A pelvic pain psychologist works with the nervous system's fear response, the anxiety and hypervigilance that build up around pain, and the sexual, relationship, and identity impacts that come with pelvic pain conditions.
Neither one replaces the other — they're addressing different, connected parts of the same loop. In fact, when researchers asked patients directly what they wished their care had included, one of the most consistent answers was access to psychological and sexual health support alongside physical treatment, in the same place, from the beginning — not sequentially, after PT alone didn't fully resolve things (LePage & Selk, 2016).
There's another piece of what a pain psychologist does that people don't always expect: helping you understand, coordinate, and optimize your overall treatment. This is a standard part of working with a health-focused psychologist highly literate in the medical system — we help you make sense of your condition, know your options, and feel empowered to advocate for yourself across providers and appointments.
For pelvic pain, that guidance matters a lot, because the condition is multifactorial and no single provider sees the whole picture. Because I trained and worked alongside pelvic pain specialist physicians early in my career, I bring a familiarity with the medical side of these conditions that most providers haven't had the chance to develop. Given how little pelvic pain training most OBGYNs receive (more on that below), I can often help patients understand what's happening in their body in ways that fill real gaps in the information they've gotten so far.
Why Didn't I Know About Pelvic Pain Therapy?
If you're wondering why no one mentioned pelvic pain therapy to you sooner, you're not alone, and it's not because you weren't paying attention. Many physicians, including general practitioners, report they weren't trained to recognize or discuss pelvic pain conditions in the first place, which delays referral to anyone who might mention psychological support at all (Leusink et al., 2018).
Even among OBGYNs, the training gap is striking: a survey of residency program directors across the US and Canada found that OBGYN residents spent a median of just 10 hours in vulvar pain clinics over the course of their entire residency (Edwards et al., 2018).
Ten hours.
You've probably spent more time than that in waiting rooms trying to get help for this condition. It's not only a knowledge gap — OBGYN residents have also reported negative attitudes toward working with chronic pelvic pain patients, modeled after mentors who felt similarly, and a sense of being unprepared by their training to meet these patients' needs (Witzeman & Kopfman, 2014). Simply put: there aren't that many OBGYNs out there with real pelvic pain training, and even fewer who feel equipped and willing to take it on.
As for myself — I only learned as much as I did about the medical side of pelvic pain because I got lucky. Early in my career, I was hired as a provider at a Center for Pelvic Pain, where I learned directly from the specialist MDs I worked alongside every day. The clinic's director was also the lead pelvic pain trainer for OBGYNs at our center and affiliated centers, which meant I could attend specialized trainings on pelvic pain diagnosis and treatment. Most pain psychologists do not get that kind of exposure, and most patients don't receive a referral to pain psychology early-enough in their journey, because providers across the board are usually not trained in pelvic pain.
Patients themselves often describe a painfully familiar pattern: feeling dismissed, having to "diagnose myself," and eventually becoming the expert in their own condition simply because no one else offered a fuller picture (Lountzi & Durand, 2024).
The good news is that this is changing. Between more visible patient communities and better search tools — including AI chatbots that can point you toward specialists you didn't know existed — it's becoming easier to find out that pelvic pain therapy is an option upfront, and not something you have to stumble into after years of searching, or after landing at the right clinic by chance, the way I did.
If you're early in this journey, or starting to wonder whether therapy could help, I'd rather you find this out now than five years from now. If you'd like to learn more, get in touch for a free consultation. I provide pelvic pain therapy via telehealth in California, New York and Florida.
References
Edwards, C., Dogra, N., Antanrajakumar, A., Sarangapani, A., & Selk, A. (2018). Vulvovaginal disease education in Canadian and American gynecology residency programs: A survey of program directors. Journal of Lower Genital Tract Disease, 22(3), 242–250. https://doi.org/10.1097/LGT.0000000000000390
Engström, A. H., Kullinger, M., Jawad, I., Hesselman, S., Buhrman, M., Högberg, U., & Skalkidou, A. (2021). Internet-based treatment for vulvodynia (EMBLA) – Study protocol for a randomised controlled study. Internet Interventions, 25, 100396. https://doi.org/10.1016/j.invent.2021.100396
Goldstein, A. T., Pukall, C. F., Brown, C., Bergeron, S., Stein, A., & Kellogg-Spadt, S. (2016). Vulvodynia: Assessment and treatment. The Journal of Sexual Medicine, 13(4), 572–590. https://doi.org/10.1016/j.jsxm.2016.01.020
LePage, K., & Selk, A. (2016). What do patients want? A needs assessment of vulvodynia patients attending a vulvar diseases clinic. Sexual Medicine, 4(4), e242–e248. https://doi.org/10.1016/j.esxm.2016.06.003
Leusink, P., Teunissen, D., Lucassen, P. L., Laan, E. T., & Lagro-Janssen, A. L. (2018). Facilitators and barriers in the diagnostic process of vulvovaginal complaints (vulvodynia) in general practice: A qualitative study. European Journal of General Practice, 24(1), 92–98. https://doi.org/10.1080/13814788.2017.1420774
Lountzi, A. Z., & Durand, H. (2024). Help-seeking experiences and intimate partner support in vulvodynia: A qualitative exploration. Women's Health, 20. https://doi.org/10.1177/17455057241241866
Witzeman, K. A., & Kopfman, J. E. (2014). Obstetrics-gynecology resident attitudes and perceptions about chronic pelvic pain: A targeted needs assessment to aid curriculum development. Journal of Graduate Medical Education, 6(1), 39–43. https://doi.org/10.4300/JGME-D-13-00072.1
Wojtas, J., Sotomska, Z., Murawski, M., & Grzybowska, M. E. (2026). Exploring the diagnostic and therapeutic pathways of women with dyspareunia: A mixed-methods study. Journal of Clinical Medicine, 15(2), 787. https://doi.org/10.3390/jcm15020787
