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I’ve said it before and I’ll say it again – pelvic pain isn’t in your head, it’s in your muscles.

But could it also be in your birth control?

That’s one of many questions a team of scientists from the European Society of Sexual Medicine set out to answer recently by taking a comprehensive look at the current body of research on how hormonal contraception can affect female sexuality.

Sadly, the first takeaway is no surprise. We need more research – a lot more. And of all the different facets of female sexuality they examined, pelvic floor and urological symptoms got the least attention from the scientific community.

But here’s what they do know for sure. Your “hormonal status influences all the tissues in the pelvic region, including bladder, urethra, and muscles”. And the limited amount of research available suggests that certain kinds of hormonal birth control leave women at increased risk of painful bladder syndrome, urinary incontinence, pelvic floor inflammation, and frequent UTIs. They can also decrease lubrication – a factor in painful sex that also contributes to a number of more serious conditions like vulvar vestibulitis or vulvovaginal atrophy.

But don’t ditch your pills, or rush to get your implant removed just yet. If your birth control method is working well for you and your partner, stick with it. If it isn’t – the right mindset and the right specialists can help.

If you’re contemplating making a switch, these three steps can make a big difference.

Treat the pain first. If you’re experiencing pelvic pain or urinary incontinence, schedule a consultation with a qualified women’s health physical therapist. Both conditions have many, and sometimes multiple, causes. Your birth control might have something to do with it, or it might not. Either way, pelvic pain is treatable; and getting to the root cause of your pain is a crucial part of what we do. That knowledge is a big help to your doctor, too.

Explore your options. The days of one size fits all birth control pills are over; contraception can and should be customized for every woman. The European research team wisely encourages providers to take into account a woman’s specific needs and expect them to change over time. Ideally, that begins with a big picture assessment of your psychological, physical, and relational needs and risk factors; and it ends with empowering and supporting your decision from among a wide variety of birth control options. But you may have to push for that. Even good doctors are used to simply writing the prescription that works for most of their patients. Let them know from the beginning – or starting today – that you’re the team expert on your body.

Insist on follow up. The European researchers suggest a three month check in with your provider after starting or switching contraceptives, especially if something isn’t working for you. Hormonal contraception isn’t the only form of birth control; but if you’re really committed to it, your provider can offer a different hormone combination, a different dose, or a non-oral medication (like a vaginal ring or implant) before recommending non-hormonal solutions.

Hormonal birth control works for many women; but there’s only one you. If you experience pelvic pain or other side effects while you’re taking it, don’t suffer in silence. The whole point of contraception is giving women the sex life they deserve. Make sure the one you choose works for your whole body, as well as your mind and relationship.


Both S., Lew-Starowicz M., Luria M., et al 2019. Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine. The Journal Of Sexual Medicine 16:11 1681-91.

What Our Patients Have to Say


Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

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 Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

Read more: Testimonial by Mary L.

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 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 Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

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