Therapy for Chronic Pelvic Pain and Painful Sex
Specialized therapy for pelvic pain associated with endometriosis, vulvodynia, vaginismus, pelvic floor dysfunction, interstitial cystitis, and other conditions affecting sexual intimacy and daily life.
In-person in Bothell and secure telehealth throughout Washington and California
You’ve been dealing with pelvic pain for months, maybe years. You’ve seen doctors, tried different treatments, and rearranged parts of your life around symptoms that still haven’t gone away.
Sitting through a work meeting leaves you aching or burning in your pelvis. Sex hurts so much that you’ve started avoiding it. You wonder whether a long drive, a dinner with friends, or physical activity will leave you in pain for hours afterward.
You want to understand why the pain keeps returning, why treatments haven’t provided lasting relief, and whether there are other ways to reduce your symptoms.
I provide psychotherapy for chronic pelvic pain, including pain during sex and pain that affects your daily life outside of sexual activity.
When Pelvic Pain Makes Sex or Penetration Painful
→ You want to enjoy sexual intimacy with your partner, but you’ve started dreading intercourse.
You remember when you could enjoy kissing and touching without immediately worrying that your partner would want to have sex. Now, when they initiate physical affection, you tense up because you’re anticipating another painful experience.
Sometimes sex causes immediate burning or sharp pain. Other times, intercourse feels tolerable at first, but afterward you experience aching or cramping that lasts for hours.
→ You’ve tried different positions, more lubricant, or stopping when the pain begins, but you still can’t predict whether sex will hurt.
You still want to enjoy sex with your partner, but pain keeps interrupting experiences you were looking forward to. You’re losing the pleasure, excitement, and spontaneity you once associated with sex. Sometimes you avoid intimacy altogether because you dread another experience that ends in pain and disappointment.
→ You’ve never experienced comfortable penetration, and you’re worried that might never change.
Maybe you’ve never been able to use a tampon comfortably. Your pelvic exams have been so painful that you dread scheduling another appointment, or you had to ask your doctor to stop before the exam was finished.
You’ve tried having intercourse, but the burning, sharp pain, or feeling that your muscles won’t allow penetration makes you stop. You’ve wondered whether you were doing something wrong, whether you needed to relax more, or why penetration seems so much easier for other people.
You might be single and worried about how pain will affect a future sexual relationship. Or you’re in a relationship and frustrated that pain has limited the kinds of intimacy you want to enjoy.
You want to understand why penetration hurts and whether you can become more comfortable with your body, without feeling pressured to endure pain to prove you’re making progress.
When Pelvic Pain Is Affecting Your Daily Life
You make decisions based on how much pain you expect to experience afterward.
Before agreeing to dinner with friends, you wonder whether you’ll be able to sit comfortably through a two-hour meal.
At work, you shift around in your chair or stand up during meetings because the aching, burning, or pressure in your pelvis makes it difficult to concentrate.
You’ve started paying attention to whether your symptoms get worse after exercise, when your bladder is full, during your period, or after sitting too long. You avoid activities that previously triggered painful flares and leave extra time in your schedule to recover.
Some days, you wake up feeling better and start hoping your symptoms are improving. Then the pain returns, sometimes without an obvious explanation, and you’re left wondering whether you overlooked an early warning sign or did too much the day before.
You resent having to plan your entire day around pain when other people can make plans without giving their bodies a second thought.
When Medical or Sexual Trauma Continues to Affect Your Body and Intimacy
Maybe you had an emergency C-section, experienced severe tearing during childbirth, or underwent a painful hysterectomy or another pelvic surgery. Perhaps something went wrong during the procedure, or you felt powerless to stop what was happening.
You may still be experiencing physical pain, but you also find yourself becoming anxious about medical appointments or sexual intimacy.
Sometimes memories of the delivery come rushing back, even when you know it’s over and you’re safe now.
You may also have experienced unwanted or pressured sexual activity.
Even with a partner you trust, certain kinds of touch may remind you of what happened. You become anxious, your muscles tighten, or you want to stop even though you initially wanted to have sex.
You want to be able to receive necessary medical care, feel comfortable with physical touch, and enjoy sexual intimacy without the same fear or distress.
You’ve Tried to Get Help, but You’re Still in Pain
You’ve spent a lot of time, money, and energy trying to find answers.
You’ve described your symptoms to doctors, undergone tests, and tried treatments such as medication or pelvic floor physical therapy. Some have helped, but you’re still dealing with pain that interferes with your daily activities, relationships, or sexual intimacy.
Maybe you’ve completed treatment for endometriosis or another pelvic condition, and your doctor says everything looks good. But you’re still experiencing pain during sex, when you exercise, or even when you’re sitting at work. You expected to feel better by now, and you don’t understand why the pain hasn’t gone away.
Or maybe you’ve undergone pelvic exams, ultrasounds, and other tests, but your doctors haven’t found a clear explanation for your symptoms. You know how much pain you’re experiencing, and you’re frustrated that no one seems to have an answer.
You’ve started wondering whether stress, emotions, or past experiences could be affecting your pain.
Perhaps you’ve noticed that your symptoms become worse during periods of intense stress, even when your physical activity hasn’t changed.
You’re interested in understanding whether addressing the stress, fear, or painful experiences associated with your symptoms could help you feel better.
What Can Change Through Pelvic Pain Therapy
Reduce Pain and Anxiety About Future Painful Flare-Ups
After months or years of pelvic pain, you might find yourself worrying about another flare before you’ve even started an activity that previously caused pain.
For example, if sitting through a long meeting has left you aching for hours afterward, you might start feeling tense before the next meeting. You pay closer attention to sensations in your pelvis, wondering whether the pain is starting again. That worry and tension can sometimes make pain feel more intense.
When increased nervous-system sensitivity is contributing to your pelvic pain, I use Pain Reprocessing Therapy to help reduce that sensitivity, with the goal of reducing the pain itself. We can also address the anxiety and anticipation that have developed around painful experiences, so you feel less afraid of another flare and, when it’s medically appropriate, more comfortable returning to activities you’ve avoided.
Rebuild Confidence and Enjoyment in Sexual Intimacy
You want to enjoy kissing, touching, and sexual activity without immediately worrying about whether penetration will hurt or how much pain you’ll experience afterward.
Therapy can help address the anxiety, physical tension, painful memories, or sexual shame that have become associated with intimacy. You can begin recognizing what feels pleasurable, communicating your preferences and limits to a partner, and approaching sexual experiences without feeling obligated to tolerate pain.
If you’ve never experienced comfortable penetration, progress might include feeling less anxious about pelvic examinations, becoming more comfortable with physical touch, or feeling more confident discussing sexual concerns with a future partner.
Want to Work on Sexual Intimacy With Your Partner?
When pelvic pain or painful sex has affected your relationship, you and your partner may want to work together on rebuilding a sexual connection that feels comfortable and enjoyable for both of you.
I also offer sexual intimacy intensives for couples who want dedicated time to address concerns such as anxiety about painful sex, differences in sexual desire, difficulties communicating about intimacy, or uncertainty about how to reconnect physically without pressure.
These extended sessions give us more time to address the concerns affecting your sexual relationship and work toward changes you can begin making together.
→ Read more about the Sex Therapy Intensive for Couples
Make Plans Without Assuming Pain Will Ruin Them
As therapy helps you respond differently to pain and the anxiety surrounding it, you can begin returning to activities you’ve avoided when they’re medically appropriate for you.
You can make decisions based on how you feel, what your medical providers recommend, and what you want to do, rather than automatically expecting another painful flare.
Imagine accepting an invitation to dinner without spending the next three days worrying about whether you’ll be able to sit through the meal, or finishing a workout without repeatedly checking your pelvis for signs that you’ve overdone it.
Instead of spending an afternoon trying to figure out whether you’ve triggered another flare, you can focus on your work, enjoy time with friends, or relax at home without giving your symptoms your constant attention.
You can spend more time enjoying your life and less time preparing for pain.
How I Help With Chronic Pelvic Pain and Painful Sex
Pain Reprocessing Therapy: Helping Change How Your Body Responds to Pelvic Pain and Painful Sex
When you’ve experienced pain for a long time, your brain and nervous system can become more sensitive to signals from your body. Sensations that once caused little or no discomfort may begin to hurt, and pain you already experience can become more intense. Your pain is real, and increased nervous-system sensitivity may be contributing to how intensely you experience it, even when there’s no new injury.
When increased sensitivity is contributing to your symptoms, I use Pain Reprocessing Therapy (PRT) to help change how you respond to pain, with the goal of reducing the pain itself. During our sessions, we’ll examine what happens when you notice a familiar sensation or anticipate an activity that has hurt before.
For example, if you immediately worry that a familiar ache means another severe flare is coming, I’ll help you examine that reaction and practice responding to the sensation without automatically expecting the worst.
We can also work on returning to activities you’ve avoided, when it’s medically appropriate. That might mean gradually getting back to running, feeling more comfortable sitting through a long meeting, or addressing the anxiety and anticipation of pain that have made sexual intimacy difficult. We’ll respect your medical needs and physical limits rather than encouraging you to push through pain.
If you have endometriosis, pelvic floor dysfunction, or another diagnosed condition, I’ll consider how your medical symptoms and pain-related reactions may be affecting each other. We can address the anxiety, physical tension, and avoidance that have developed around your symptoms. And if increased nervous-system sensitivity is contributing alongside your medical condition, PRT may help reduce your overall pain.
Somatic Therapy: Addressing Physical Tension Associated With Pain
You might notice that your pelvic muscles tighten, your breathing becomes shallow, or your body becomes tense before sexual activity or a medical exam. Sometimes those reactions happen before you’ve consciously recognized that you’re anxious.
With somatic therapy, I’ll help you become more aware of those physical responses and work on reducing the tension associated with anticipating pain. We can also address what happens when discomfort begins, so you feel more confident recognizing when you need to stop, change an activity, or respond to your body’s needs.
EMDR: When Medical and Sexual Trauma Affect Pelvic Pain
Even when a painful or traumatic experience is over, memories of what happened can continue triggering anxiety, physical tension, and other reactions that interfere with medical care or sexual intimacy.
I use EMDR (Eye Movement Desensitization and Reprocessing) to help you process distressing memories so that they no longer provoke the same intense emotional and physical responses.
For example, if you become anxious and physically tense before pelvic examinations because of a previous medical experience, we can use EMDR to address the memories associated with those reactions. You can start to feel more comfortable receiving medical care without the same fear or anticipation of what happened before.
If unwanted or traumatic sexual experiences have made certain kinds of touch upsetting, we can work on reducing the distress associated with those memories so that you’re able to enjoy consensual sexual touch without traumatic memories triggering fear, tension, or an urge to pull away.
When trauma-related anxiety or physical tension is contributing to your pelvic pain, addressing those responses may also help reduce the pain itself.
When Sexual Shame or Religious Teachings Are Part of Chronic Pelvic Pain and Painful Sex
Maybe you grew up being taught that sexual desire was sinful, that a Godly wife shouldn’t refuse sex, or that sex was an obligation once you were married.
Now intercourse hurts, but you feel guilty when you tell your partner you want to stop. Sometimes you continue even after the pain starts because you’re worried about disappointing them or having an argument afterward.
Through my work with people recovering from religious trauma and purity culture, I’ve seen how teachings about sexual obligation, modesty, and obedience can continue influencing someone’s relationship with their body and their ability to make decisions about sexual intimacy.
I’ll help you recognize when guilt or pressure to prioritize your partner’s satisfaction is keeping you from speaking up. We’ll address any anxiety you experience when you tell your partner something hurts, ask to stop sexual activity, or express a sexual preference that differs from theirs.
If your partner pressures you to continue sexual activity despite pain or becomes angry when you want to stop, we’ll also address how their behavior is affecting your sense of safety and your ability to make choices about intimacy.
If you’ve been part of a high-control religious or spiritual group, you may have experienced additional pressure to comply with sexual expectations, disregard physical discomfort, or accept someone else’s authority over your body. In my work with people recovering from spiritual abuse and high-control groups, I help address how those experiences continue affecting their sense of bodily autonomy, sexual boundaries, and intimate relationships.
Sexual shame can also develop through family attitudes about sex, previous relationships, or experiences where your sexual needs were dismissed. We’ll talk about how those experiences continue to affect your desire, enjoyment, and ability to communicate during intimacy.
Therapy That Complements Your Medical and Pelvic Floor Treatment
You can continue receiving medical treatment for pelvic pain while we address the difficulties that haven’t improved through medical care alone.
For example, your pelvic floor physical therapist may be helping you address muscle tension, while I help you manage the anxiety that developed after repeated painful attempts at intercourse.
If you’re receiving treatment for endometriosis, we can address the emotional toll of unpredictable symptoms, the activities you’ve started avoiding, or the strain pain has placed on your relationship.
Medical treatment and psychotherapy address different contributors to pelvic pain. Your medical providers can evaluate and treat physical conditions, while I address pain-related anxiety, nervous system sensitivity, distressing experiences, and relationship concerns that may be contributing to your symptoms.
When these factors are affecting each other, addressing them together can help reduce pain.
Who Is Pelvic Pain Therapy a Good Fit For?
Psychotherapy for chronic pain can be especially helpful when pain continues despite medical treatment, when tests haven't fully explained your symptoms, or when you've become increasingly sensitive to activities and sensations that didn't previously hurt.
If You Have a Medical Diagnosis
I work with clients experiencing pelvic pain associated with conditions such as endometriosis, vulvodynia, vaginismus, genito-pelvic pain/penetration disorder (GPPPD), pelvic floor dysfunction or hypertonicity, and interstitial cystitis (bladder pain syndrome).
If You Have Pelvic Pain Without a Clear Diagnosis
You may experience burning or sharp pain during penetration, aching or cramping after intercourse, or pelvic discomfort that makes sitting, exercising, or getting through your workday difficult.
You may also find that anticipating pain has made it difficult to become aroused, experience pleasure, or reach orgasm, even when you want to be sexually intimate.
Perhaps you experience pelvic cramping during or after orgasm, even when penetration isn’t involved.
Or you’ve never been able to insert a tampon comfortably, pelvic examinations have always been painful, or you experience pressure or aching in your pelvis even when you aren’t sexually active.
You can start therapy while you continue working with your medical providers to investigate the cause of your symptoms. We’ll focus on the concerns psychotherapy can address without requiring you to have a definitive diagnosis before getting help.
Whether You’re Sexually Active or Not
I work with sexually active and sexually inactive clients, including people who have never had intercourse, people who have stopped having sex because of pain, and LGBTQIA+ and gender-diverse clients experiencing pelvic pain or painful sexual activity.
For some transgender and nonbinary clients, gender dysphoria can affect how they experience genital touch, sexual intimacy, or pelvic examinations. I’ll consider those concerns alongside any medical conditions or other contributors to your pain, without assuming that your gender identity or sexual orientation is the cause.
Whether or Not You Have a History of Trauma
You don’t need to have experienced trauma for pelvic pain therapy to help. Chronic pelvic pain can develop for many reasons, and you may have a medical diagnosis, several contributing factors, or no clear explanation for your symptoms.
I’ll consider your medical history, symptoms, and experiences to identify whether pain-related anxiety, nervous-system sensitivity, or other concerns that psychotherapy can address may be contributing to your pain. We’ll use that information to determine which treatment approaches may be helpful for you.
How to Get started in chronic pelvic pain therapy
Therapy for Pelvic Pain and Painful Sex: Pricing and Scheduling
Insurance and Payment
Individual therapy: $300 per 50-minute session
I’m a private-pay therapist and don’t bill insurance directly.
If your insurance plan includes out-of-network mental health benefits, I can provide a Superbill for individual therapy that you can submit for possible reimbursement. You can also use eligible HSA or FSA funds toward your sessions.
→ View Full Pricing and Payment Information
Service Locations
I provide individual therapy for chronic pelvic pain and painful sex through secure online appointments for adults located in Washington and California, as well as in-person appointments at my office in Bothell, Washington.
Scheduling Your First Appointment
You can request your first appointment directly through my secure online calendar by clicking the button below.
Once I approve your appointment request, you’ll receive the intake forms to complete before we meet.
Your first session gives us time to discuss your symptoms, medical history, previous treatments, and what you want to change. We’ll begin identifying where psychotherapy may be helpful and which treatment approaches make sense for you.
About Ingrid Johnston, LMFT, MDFT
Therapist for pelvic pain and painful sex
My background includes specialized training in Pain Reprocessing Therapy, EMDR, somatic therapy, and sex therapy, along with advanced certification in Medical Family Therapy and Collaborative Medicine.
I’ve worked with people experiencing sexual pain, difficulties with penetration, sexual shame, and other concerns that affect their ability to enjoy intimacy. I have a particular interest in how medical trauma, sexual trauma, and harmful religious teachings or experiences can affect someone’s relationship with their body and contribute to ongoing pain. I also work with people whose pain has no connection to trauma or has no clear explanation.
I’ve experienced chronic pain myself and know how discouraging it can be when you’ve invested time and money in treatment but still don’t have the relief you hoped for.
I bring that personal understanding alongside my clinical training. When we meet, I’ll consider your medical history, your experiences with pain, and the concerns that are most important to you so we can focus treatment on meaningful improvements in your symptoms and daily life.
Questions?
FAQs About Chronic Pelvic Pain Therapy
Don’t see you question asked and answered here? Check out my FAQ page.
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In the clinical trial, most people began experiencing significant pain reduction within 4 weeks of treatment, with 66% reporting being pain-free or nearly pain-free by the end of treatment. However, everyone’s timeline is different. Some people notice changes within the first few sessions, while others need more time to retrain their nervous system. We typically work together for several months to ensure lasting results.
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PRT is most effective for pain caused by the nervous system rather than structural damage. This includes most cases of chronic back pain, neck pain, migraines, fibromyalgia, IBS, and other conditions where medical imaging shows no structural cause. It’s less effective for pain caused by active tissue damage, infections, tumors, or progressive diseases. That’s why a thorough assessment is the first step.
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Yes. Even when pain begins with a real injury, it often persists long after the injury has healed because the nervous system has learned the pain response. If your pain has lasted beyond the normal healing timeline (typically 3-6 months), continues despite healed tissue, or varies unpredictably, neuroplastic pain may be maintaining it even if it started with an injury.
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No. You can continue your current medications, physical therapy, or other treatments while doing PRT. Many people find they naturally reduce or eliminate these treatments as their pain decreases. However, it’s important to work with your medical providers on any changes to medications or treatment plans.
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CBT for pain typically focuses on managing pain through coping strategies, thought modification, and behavior changes, essentially learning to live better with pain. Pain Reprocessing Therapy works to eliminate pain by retraining the brain to correctly interpret body signals. While both are evidence-based, PRT aims for pain elimination rather than pain management.
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Sessions typically involve education about how your specific pain works, somatic tracking exercises where you pay attention to sensations in new ways, processing emotions or stress that may be fueling the pain cycle, and gradually approaching movements or activities you’ve been avoiding. We also work with any trauma, perfectionism, or life stress that keeps your nervous system on high alert.
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No. This isn’t about positive thinking, affirmations, or convincing yourself the pain isn’t real. The pain is completely real, and changing your thoughts alone won’t eliminate it.
Here’s what happens: Your brain has learned to produce pain as a protective response, even when there’s no tissue damage to protect you from. This learned response is maintained by fear: when you interpret pain as dangerous, your nervous system stays on high alert and keeps producing pain signals.
Pain Reprocessing Therapy works by teaching your brain to accurately interpret body signals again. This requires specific techniques; not just thinking differently, but actually experiencing sensations in your body differently, working with fear responses, and systematically breaking the connections between activities and pain.
It’s more like retraining yourself out of a fear than positive thinking. If you’re afraid of dogs, you don’t overcome it by telling yourself “dogs are great!” You overcome it through gradual exposure that teaches your nervous system dogs aren’t actually dangerous. PRT does the same thing with pain signals.
The reason it works is because the pain has been learned, not by damaged tissue. Retraining that learned response can eliminate the pain quickly.
Have a Question Before Booking?
If you have a question about working together, please contact me using the button below. I’ll respond via email within 2 business days.