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Mental Health and Sexual Pain | Image Courtesy of Anthony Tran via Unsplash
Mental Health & Sexual Pain | Image Courtesy of Anthony Tran via Unsplash

Mental Health and Sexual Pain: Sexual Dysfunction is Not “In Your Head”.

We have seen that experiencing sexual pain CAN affect your mental health, and pre-existing mental health conditions can amplify sexual dysfunction.

This article will review the research related to these, but in reading, know that we believe your pain is real and should be addressed from all relevant contributing factors.

A very large range, about 7-46% of Americans may experience painful sex. For some, it may be a one-time painful experience, and for others, it may be every single time. This can have a huge effect on mental health and overall quality of life.

There may be an underlying reason for the pain, such as dermatological issues, perineal trauma from childbirth, chronic UTI or yeast infections, hormonal deficiencies, endometriosis, high pelvic floor muscle tone, etc. Unfortunately, whatever the cause may be, this can cause a cascade of events, and greatly affect our mental health.

One study of older women (aged 50-99) suggested that sexual health is linked more strongly to mental health than to physical function, stress, or age itself. However, the reverse of this is also possible, as those with mental health disorders may be at increased risk for sexual dysfunction disorders. According to Basson & Gilks, psychiatric disease is the most important risk factor for sexual health disorders. More recent research highlights the high possibility that there is an underlying vulnerability to both psychiatric disease and sexual dysfunction.


If one has pain while engaging in sexual activities, it is understandable that one would feel frustrated and perpetuate the depressive thoughts. Depression not only may worsen or affect sexuality physically, but it can also affect our sexual arousal and desire, thus affecting our ability to feel pleasure during sexual activity. The Study of Women’s Health Across the Nation (SWAN) confirmed history of recurrent depression to be associated with reduced sexual arousal and reduced sexual pleasure. Even in those that are not diagnosed with clinical depression, our moods can certainly affect sexual function and vice versa. 


Not only are anxiety disorders a risk factor for low sexual desire or arousal, there is also research that ties anxiety with difficulties achieving orgasm and experiencing pain with sex. In addition, provoked vestibulodynia is ten times more common in women with a history of anxiety disorders. This may be related to the upregulation of the sympathetic nervous system (think “fight or flight” or “freeze”.) When we are more consistently in an upregulated state, sympathetic nerves that are connected to the pelvic floor muscles may cause tension unconsciously. Over time, tense or guarded muscles can develop trigger points, and can create pain with sexual activity.


Sexual dysfunction is intimately connected with stress, anxiety and depression. Please check out our blog post regarding chronic stress and its impact on your sex life. Of all, depression has the most impact when it comes to sexual function. Treatment should be inclusive and not only include the physical aspect of pain, but also the interpersonal, psychosocial and environmental factors as well. As pelvic floor physical therapists, we can help treat your symptoms physically (pelvic floor muscles, hips, low back, abdominals!), incorporate techniques to help downregulate your autonomic nervous system, and work with you alongside with a mental health professional. As a team, we can help you improve your sexual and mental health! 


Basson R & Gilks T. Women’s sexual dysfunction associated with psychiatric disorders and their treatment. 2018. Women’s Health; 2018;1-16. doi : 10.1177/1745506518762664

Sorenson J. Bautista KE, Lamvu G, Feranec J. Evaluation and Treatment of Female Sexual Pain: A Clinical Review. Cureus 10(3): e2379. DOI 10.7759/cureus.2379

Tayyeb M, Gupta V., Dyspareunia. [Updated 2021 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. 

Yazdanpanahi Z, Nikkholgh M, Akbarzadeh M, Pourahmad S. Stress, anxiety, depression, and sexual dysfunction among postmenopausal women in Shiraz, Iran, 2015. J Fam Community Med 2018;25:82-7.

What Our Patients Have to Say


Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by S.B.

As someone who suffered the debilitating physical and emotional effects of vaginismus (as well as a complicated history of back injuries) for more than 15 years, I thought a "normal" life was just a fantasy. Then I found Heather.

Read more: Testimonial by S.B.

Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by Rosanna R., age 35

Heather has affected my life in the MOST POSITIVE way and I am forever grateful. My husband refers to her as the "sex doctor" so you can only imagine how happy he is with my therapy outcome.

After the birth of my son I suffered from "Vaginismus", however, at the time I just thought I was broken. My "broken vagina" affected me physically but it was an emotional struggle as well. Many women in my life also suffered with pain from sex after their babies were born so I knew I wasn't alone. They told me they "just got used to it" but I couldn't see myself living that way.

Sex wasn't just painful, it was literally impossible - IT DIDNT FIT!

Read more: Testimonial by Rosanna R.,...

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

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