"No, YOU Relax!" A Therapist’s Take on Pelvic Pain
- 5 days ago
- 7 min read
Speaking as a therapist and a human, I am fed up with pelvic pain being dismissed by healthcare providers. So, I thought I would write an article to try to help. Talking about pelvic pain takes courage. It can show up during some of the most vulnerable experiences someone can have: intimacy, periods, medical exams, trying to conceive, using the bathroom, moving through your day, or simply trying to exist comfortably in your own body. And when you finally work up the courage to talk about it, you deserve to be met with curiosity, care, and motivation to help you find answers. Far too often, though, people with pelvic pain are met very unhelpful responses like:
“You just need to relax.”
“Everything looks normal.”
"It's in your head."
All of these are examples of real phrases our clients have heard. While stress, anxiety, trauma, and emotional distress can absolutely play a role in pelvic pain, that does not mean pelvic pain is imaginary. It also does not mean every person with pelvic pain has an obvious trauma history, an anxiety disorder, or a simple emotional explanation for what is happening in their body.
Many people with pelvic pain have been through multiple scans, labs, exams, appointments, and opinions, only to be told that everything looks “completely normal.” That experience can be incredibly isolating. It can make you question yourself. It can make you feel humiliated, even though you have nothing to be embarrassed about. It can feel like you have to start from square one over and over again, retelling the same vulnerable story and hoping the next person will finally understand what you are trying to say.
So, why can you have pelvic pain even when your scans are normal?
Because a single scan or test or even multiple scans or tests may not be able to clearly identify the source of your pain. Scans or tests may be used to check whether your anatomy looks typical, whether there are visible cysts, masses, lesions, infections, or other obvious abnormalities. That information matters, but it is not necessarily the whole story. Clear scans do not mean your pain is imaginary. Pelvic pain may not be explained by a single test and there may be more to explore.
If a provider only looks at anatomy but not hormones, something may be missed. If they only look at hormones but not pelvic floor tension, something may be missed. If they only look at trauma or anxiety but do not take your physical symptoms seriously, something may be missed. A thorough pelvic pain evaluation often requires attention to multiple possible causes, not just one narrow explanation.
A Holistic Approach to Pelvic Pain
At Philosophie Therapy, we take a different approach. If you live in Florida and have been dismissed, minimized, or made to feel like you are being dramatic, we would love the opportunity to help.
Pelvic pain can exist at a unique intersection of the physical and the psychological. It is not necessarily purely medical or purely emotional. Pelvic pain can be complex and multifaceted. It can involve your anatomy, hormones, nervous system, pelvic floor muscles, stress response, relationship history, trauma history, medical history, and the way your body has learned to protect itself over time. When only one piece of that puzzle is explored, it is easy to feel lost.
We live in a world where different forms of medical treatment are highly specialized, and that can be an incredible thing. It means you can receive specialized feedback for specific problems. A gynecologist may be looking at one part of the picture. A pelvic floor physical therapist may be looking at another. An endocrinologist may be thinking about hormones. A mental health therapist may be thinking about stress, trauma, anxiety, and relationships. All of that specialization can be helpful, but it can also feel incredibly segmented.
You can start to feel like you have become the administrator of your own health problem. You are the one remembering what each provider said, keeping track of which tests were normal, explaining the same symptoms over and over again, researching what to ask next, trying to decide which specialist to see, and carrying the emotional burden of wondering whether anyone is seeing the whole picture.
Philosophie Therapy offers online mental health therapy services to Florida residents struggling with pelvic pain. Mental health is the primary focus of the work we do, but we do not assume it is the only work to be done.
Our process includes a few different steps:
1. Gathering Data
One of the first goals is to gather as much data on your pain as possible. We want to partner with you to become scientists studying your experience. A good scientist doesn’t immediately draw conclusions; they gather data and ask important questions. For example, what do you notice about your pain? When does it show up? Does it change around your cycle? Does it appear after certain types of stress, intimacy, exercise, conflict, medical appointments, or long periods of pushing through? Does it feel different when you are overwhelmed, exhausted, disconnected, scared, or bracing yourself emotionally? When we have enough data, we can start to develop a holistic picture of what is happening.
2. Redirecting Energy
Living with pelvic pain can take up so much emotional energy. This is where therapy can be especially helpful. A large part of therapy is learning to separate what you can control from what you cannot. You cannot control your genetics. You cannot control how long it has taken to get answers. You cannot always control whether a provider understands you. You cannot force your body to heal overnight. But you can control where your energy goes next.
You can decide to stop spending all of your emotional energy on self-blame. You can choose to document your symptoms more clearly. You can build a care team that takes you seriously. You can learn how to regulate your nervous system when pain sends you into panic. You can practice responding to your body with curiosity instead of fear. You can begin telling a different story about yourself.
This does not mean you need to come up with more energy to do more things. Most people with chronic pain are already exhausted. It means redirecting energy that is being spent in painful, circular, self-punishing places and moving it toward something that can actually support you.
3. Understanding the brain-pelvis connection
Pelvic pain is not “just anxiety.” But anxiety, stress, trauma, and chronic emotional overwhelm can absolutely influence the body. The pelvic floor is not separate from the rest of you. It is made of muscles, and like other muscles, it can tighten, guard, brace, or hold tension when your body senses a threat.
So, can pelvic pain be caused by anxiety?
Anxiety can trigger pelvic pain, but that does not mean all pelvic pain is caused by anxiety. When you are anxious, it is possible that your body may experience tension that can create or worsen pelvic pain. This pain can lead to more anxiety, and more anxiety can lead to more tension and thus more pain. The cycle I’m describing is one possible phenomenon that could lead to pelvic pain; it does not mean that you are “just anxious” or “need to relax.” There are a multitude of physical and psychological factors that can contribute to pelvic pain. Anxiety is just one of these factors.
Therapy can help identify your specific emotional triggers, reduce the sense of panic around pain, and help your body learn that it does not have to stay in a constant state of bracing. For some clients, this work may happen alongside pelvic floor physical therapy, medical care, hormone evaluation, or other forms of support.
4. Building your team
A holistic approach often means accepting that one provider may not be the whole answer. That does not mean you need every specialist under the sun. It does mean you deserve support that matches the complexity of what you are experiencing. For some people, that team may include a gynecologist, pelvic floor physical therapist, endocrinologist, pain specialist, primary care provider, or another medical professional who can look at pieces of the picture that therapy does not treat directly.
Part of our bespoke therapy services involves helping you identify what you may need next. Sometimes that means helping you prepare for an appointment, organize your symptoms, advocate for yourself more clearly, or process the discouragement of having to seek yet another opinion. Sometimes it means helping you recognize that a provider is not taking your concerns seriously and that you are allowed to look for someone who will. With the help of a therapist, you can have emotional support in building a team that will support you.
5. Creating a sustainable plan
Eventually, the question becomes: with everything we are learning, what is actually sustainable?
A sustainable plan may include tracking symptoms without becoming consumed by them. It may include hormone therapy or physical therapy. It may include communicating differently with your partner. It may include saying no to things that intensify stress.
And to be honest, a sustainable plan may not always mean a world where all pain is completely gone. For some people, that may be possible. For others, healing may look like understanding the pain more clearly, reducing the distress around it, decreasing the intensity or frequency of symptoms, knowing what helps, knowing who to call, and no longer feeling like you are crazy or alone. Even when you cannot control every symptom, you can learn to care for yourself as holistically as possible.
Start Mental Health Therapy for Pelvic Pain Today!
You don’t have to drive yourself crazy trying to heal your pelvic pain alone. If you are anywhere in Florida and would like to work with a therapist who is passionate about helping people with pelvic pain, schedule a free phone call with me today! I would be more than happy to speak with you and answer any and all questions you may have about our services. Thank you for reading, and I hope to speak with you soon!
Written by Hannah Mayderry, LMHC
Owner of Philosophie Therapy LLC