Pelvic and Genital Pain: What You Should Know
Written by Elizabeth Bird, PhDCompared to some of my other recent blog posts, this one might be a little less “fun.” But it addresses a very common and important topic: pain. More specifically, pelvic and genital pain (including anal and rectal pain).
Many people experience unwanted pain during sexual activity for a variety of reasons. Sometimes that pain is with external touch to the genitals or with penetration, arousal, or orgasm. Sometimes it’s not during sexual activity at all, but while sitting, walking, or simply moving through the day. Pain can occur in the genitals or anywhere in the lower region, including the lower abdomen. And just like pain anywhere else in the body, the quality and consistency of the pain can vary.
You might be more likely to hear about cisgender women experiencing genital/pelvic pain, but the reality is that anyone of any gender can experience this pain. Some people have always experienced pain, while others start to experience pain with pregnancy or childbirth, from physical trauma, from infections or skin/tissue issues, from sports or physical hobbies, with aging, illness, and many other reasons.
Unfortunately, people who experience pain with sex are more likely to see multiple providers before finding answers, and more likely to hear dismissive messages such as “just try to relax” or “have a glass of wine.” Women, in particular, often receive the message that their pain isn’t real. This is not only invalidating, it can delay people from getting the care they deserve.
The Pain Is Real
There are many reasons people experience pain. But one thing is always true: if someone is experiencing pain, the pain is real.
Physiological, psychological, and social factors need to be assessed. Unfortunately, not all providers have the training needed to assess sexual pain. Although it is common (and often best) to see multiple types of specialists especially when trying to figure out why you’re experiencing pain, many people end up having to see multiple providers just to feel taken seriously in the first place.
Who Can Help
There isn’t just one provider who “owns” the assessment of pelvic or genital pain. Usually, a team approach works best because each specialty brings different training. Depending on their expertise, each may emphasize or be skilled at different aspects. A gynecologist might notice a muscular issue and refer to a pelvic floor PT, while a PT might spot something that warrants a gynecology or urology follow-up.
For example, a gynecologist, urologist, or pelvic floor physical therapist may look at:
The health of genital and rectal tissues
Nerve function
The role of the pelvic floor muscles (whether they are too tight, too weak, or otherwise imbalanced)
Structural or medical issues that could be contributing to pain
For pelvic floor physical therapists specifically, they also assess how other areas of the musculoskeletal system like hips, lower back, or core muscles may be affecting pelvic floor function
A therapist can play an equally important role in your care. Therapy can help you:
Address the fears, anxiety, and avoidance that make intimacy stressful (and maybe more painful)
Process and heal from past trauma connected to sex or medical experiences
Rebuild confidence in your body, sexuality, and self-image
Eliminate shame, guilt, and self-blame
Explore pleasure and (re)connect with desire
Expand your sexual menu so intimacy feels possible, safe, and even joyful again
Work as a team if you are in a relationship
Learn to express your needs or set boundaries during sex instead of hiding your pain
Prepare for or get more comfortable with having to have a physical medical exam
When Trauma Is Part of the Picture
Sometimes having a provider look at or touch your genitals can be nerve-wracking, especially if you have a history of trauma (or even if you don’t!). Any good provider should practice trauma-informed care. This means they are attentive to your emotional experience and will work with you to feel as safe and supported as possible.
For example, a pelvic floor physical therapist might wait to do a physical exam until they’ve asked other assessment questions and gotten to know you. They may also help you gradually get comfortable with steps like lying on the exam table before doing any internal exam. Clear communication, permission at every step, and the option to stop if you’re uncomfortable are all essential parts of trauma-informed care.
The Bottom Line
Pelvic and genital pain is more common than many people realize, and anyone can experience it. You deserve to be taken seriously. If you are experiencing pain, the best approach usually involves a team that includes both mental health and medical professionals. With the right support, it is possible not only to reduce or eliminate pain, but also to reconnect with your body, your partner(s), and your pleasure.
If you are interested in talking to a therapist about genital/pelvic pain, read more about Dr. Bird’s training and experience by clicking on the button below. If needed, Dr. Bird can also help connect you with trusted medical professionals for further assessment.
