Pain With Intimacy? How One Woman Rewired Her Anxious Brain to Achieve the Sex Life She Deserves.

Shelby (name changed for confidentiality) is a recently married, busy student in her mid-twenties. Shelby experienced 'extreme pain' at the vaginal opening during intimacy, rating it 8/10 and causing her to avoid and lose interest in sex.


She's aware of being highly anxious and noticed a growing strain on her marriage because of her fear of intimacy. She worried that this could cause irreversible damage to her relationship if she didn't address this issue. Her supportive husband expressed concern about causing further harm to his wife and encouraged her to see her medical doctor.

She consulted with her gynecologist, who found no major underlying medical cause for her symptoms and referred her to pelvic physical therapy.



Shelby received treatment at EMH Physical Therapy, a practice that has a mind/body healing approach. She learned about pain science, understood why she felt pain, plus implemented self-care techniques to lower her fear of penetration.


She received a total of 7 treatments, seen twice a week. In less than a month, she returned to pain-free intercourse. Her Pelvic Pain Questionnaire results improved from 50% impaired to 2% impaired.


Shelby experienced rapid progress! How is this possible?


1. Retraining her hyper-vigilant nervous system and brain.

The brain's role is to protect the body and will send pain if it receives too many signals of danger from the nervous system. The nervous system needs to be retrained to 'see" a function (ie vaginal penetration) from one that's dangerous to one that's natural and safe.

We educated her about pain science, implemented sleep hygiene, stress management techniques and incorporated physical activity into her weekly routine.

2. Become aware of types of thoughts and emotions.

Our thoughts and emotions can contribute to the pain experience. For people in chronic pain, fear spreads, or in other words- "generalizes." Fear of doing an activity that now hurts can activate your body's stress response, increasing pain signals to the body.

Positive thoughts/emotions can slow the spread of fear.

Shelby was educated on positive self-talk, and how her expectations regarding sexual intercourse can influence how she experiences pain.

3. Desensitizing pelvic floor muscles via manual techniques.

Shelby's pelvic floor muscles were gently stretched and mobilized in the clinic. Her body learned that stretching tissues was not dangerous but instead safe. Shelby was taught to maintain her progress using personal dilators at home.



4. Husband's Involvement.

Although the body never forgets a past memory, the nervous system is "plastic" or teachable to unlearn faulty patterns. The nervous system and brain can inhibit a bad memory by creating new neural pathways to respond to intimacy as safe. With this in mind, Shelby taught her husband how to stretch her pelvic floor muscles with her personal dilators. This allowed Shelby's nervous system to rediscover her husband's touch as non-threatening and safe.



5. Movement is Medicine.

Exercise can help desensitize the overused pain loop, like being in a hamster wheel. Shelby was diligent about performing her movement program.

Shelby progressed through her journey very quickly due to her diligence with her home exercise routine, her high level of mental focus during her sessions, and her personal decision to make her recovery a priority.

For those with chronic pain, recovery can take several months; regardless of the length of your journey, EMH Physical Therapy is here to help. If these symptoms sound familiar, please reach out to us at EMH Physical Therapy to begin your journey to recovery.


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1,2,3 Schneider, E. (2020) ‘Fear (Threat and Safety)’ [Powerpoint Presentation]. (Accessed June 2020)


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