Navigating Intimacy When You Have Chronic Pelvic Pain
How to stay connected, communicate clearly, and rebuild trust in your body
Let’s talk about something that almost no one wants to bring up, but so many of us are silently struggling with:
Navigating intimacy when you are a person living with chronic pelvic pain.
If you’ve ever felt anxious before sex, avoided physical closeness, or pushed through pain because you didn’t want to disappoint your partner.
You are not:
Alone
Broken
“Too Sensitive” or “failing at intimacy”
You’re navigating something complex: a body that is fighting to protect itself.
As a pelvic health occupational therapist, I work with people every day who want to feel safe in their body again. People who miss feeling spontaneous. People who miss feeling close without fear of pain. People who want their relationship to thrive, but feel like pelvic pain has taken over their identity.
This post is here to remind you:
Intimacy is still possible. It may just need a new approach.
First, let’s normalize what chronic pelvic pain can do to intimacy
Chronic pelvic pain doesn’t just affect the pelvis. It affects your nervous system, your confidence, your relationship, and your sense of safety.
Over time, pain can lead to:
Fear or anxiety before intimacy
Tensing or bracing without realizing it
Pain with penetration (or even pain with arousal)
Avoidance of touch, even non-sexual touch
Shame, grief, or feeling “broken”
Resentment or disconnection in relationships
Feeling pressured to perform or “get back to normal”
And here’s the part people don’t hear enough:
Pain during sex is not something you should just push through.
Your body is giving a signal that it needs assistance.
Pelvic pain is NOT “in your head”, but your nervous system IS involved
Many people feel invalidated when they’re told stress, anxiety, or trauma might be contributing to symptoms.Understandably so, when you’re experiencing real, life-altering symptoms, that can sound like someone saying:
“Your pain isn’t real.”
But that’s not what this means at all.
Your pelvic floor is a part of your protective system. When your brain perceives danger (physical or emotional), the pelvic floor can tighten as a reflex.
So if you’ve experienced:
Pain for a long time
Medical trauma
A difficult birth experience
Past sexual pain
Chronic illness stress
Feeling dismissed by providers
High anxiety or hyper-vigilance in your body
It makes perfect sense that your body would respond to intimacy with guarding, tightness, or pain.
The goal isn’t to “push through” these feelings. The goal is to help your body see that you’re listening to its signals, and that intimacy can be safe again.
Redefine intimacy for your and your partner
The most healing mindset shifts I see for couples is:
Intimacy does not equal penetration.
Intimacy can be:
Cuddling and feeling held
Kissing without expectations
Showering together
Massage or skin-to-skin contact
Laughing and being playful
Emotional closeness and deep conversation
Mutual pleasure without penetration
Taking sex off the table temporarily while you rebuild safety
Sometimes the most powerful thing you can do is give yourself permission to explore closeness in a way that doesn’t require your body to “perform” in a way it doesn’t feel safe.
The pressure to “just do it” makes pain worse
If you’ve ever told yourself:
“I should be able to do this.”
“My partner has needs.”
“It’s been too long.”
“I don’t want them to feel rejected/bored.”
You’re not alone.
But here’s the truth:
Pressure and obligation activate the nervous system.
When your nervous system is activated, it is totally natural for the pelvic floor to tighten.
If intimacy feels stressful, your body is likely to respond with pain, not because either of you is doing something wrong, but because your body is remembering something that happened in the past and is trying to protect you.
Self-exploration is a valuable tool for learning what feels good for you in intimate situations.
By using self-exploration, when you come to your partner to discuss how you’re feeling, you can give tangible alternatives that you already know feel good for you. The key is to focus on increasing the variety of activities you can enjoy together. Focusing on activities and open communication that strengthens both intimacy and trust between you both. This can help increase feelings of connectivity between you and your partner, and the process of sharing what feels good can actually strengthen the bond you already share with each other.
You can also try a traffic-light system:
Green: feels safe / enjoyable
Yellow: uncertain / needs slowing down
Red: stop immediately
This takes the guesswork out and helps both people feel more secure.
Practical ways to make intimacy more comfortable (and less scary)
These are simple changes that often make a huge difference:
1) Start with nervous system regulation
Before intimacy, try 3–5 minutes of something calming:
Slow breathing with long exhales
Legs up the wall
Heat pack to the pelvis or low back
Gentle pelvic rocking
A short guided meditation
Dim lights + calming music
Your body needs to feel safe before it can soften.
2) Use more time and more lubrication
Pain often increases when there’s rushing, dryness, or pressure.
Take your time with arousal
Use a high-quality lubricant
Avoid pushing through discomfort early on
Remember: more time = more safety and more pleasure
3) Adjust positioning
Some positions place more load on the pelvic floor, hips, or low back.
Often more accommodating options include:
Side-lying (spooning)
You on top (more control over depth/speed)
Supported with pillows under hips/knees
Avoiding deep hip flexion
4) Consider “intimacy without penetration” for a season
This is not giving up. It’s rebuilding trust.
Your body learns through repetition:
“I can be close and safe and nothing bad happens.”
5) Track patterns without obsessing
Sometimes pain is worse with:
Constipation or bloating
Ovulation or PMS
High stress weeks
Poor sleep
A flare of chronic illness
Hip/back tightness
You don’t need to overanalyze, but keeping a journal that tracks the patterns can help you plan intimacy around days you know your body is more likely to be having a low pain day.
If you’re feeling disconnected from your partner, you’re not alone.
Chronic pelvic pain can make people feel:
Guilty
Frustrated
Lonely
“Too much”
Like a burden
But intimacy isn’t just about physical safety, it’s emotional safety.
Sometimes the most intimate thing you can do is tell your partner exactly what you’re feeling in your own words.
That honesty becomes a bridge to more intimate moments in the future.
When to seek pelvic health support
If you’re experiencing any of the following, pelvic health therapy can help:
Pain with penetration or pelvic exams
Burning, stinging, or sharp pelvic pain
Tightness that feels impossible to relax
Pain with arousal or orgasm
Vaginismus (involuntary tightening)
Vulvar pain / vestibulodynia
Hip, SI joint, or low back pain linked to pelvic symptoms
Fear-based tension and avoidance
A pelvic health provider can help you address these issues using some of the following treatments:
Pelvic floor tension and coordination
Breathing + pressure management
Hip/core/pelvic mechanics
Fascial restrictions and scar tissue
Nervous system regulation
Pain education + graded exposure
Whole-body contributors (posture, habits, bowel/bladder function)
A reminder you may need to hear today
You are not failing at intimacy.
Your body is communicating.
You deserve pleasure that feels safe.
Healing is possible, and you don’t have to navigate this alone.
Want support?
If you’re struggling with intimacy and chronic pelvic pain, pelvic health occupational therapy can help you reconnect with your body, reduce symptoms, and rebuild confidence, without a one-size-fits-all plan.
You deserve care that is personalized, trauma-informed, and rooted in real-life function.
Ready to take the next step?
👉 Click here to submit a form for a free consultation
📍 Serving clients in Tampa, FL + virtual support options