Tag Archive for: Pelvic Pain

Painful Speculum Exam? The Essential Guide to Preparing for a Pap Smear

Is it painful when you have a speculum exam for a Pap smear?

Or are you nervous just thinking about your next appointment?

If so, this is for you.

As a women’s health physical therapist, one thing that frustrates me is that women are expected to go in for important pelvic exams without ever being taught how to prepare for them.

A painful speculum exam can feel intimidating and uncomfortable, especially if your pelvic floor already has difficulty relaxing.

Most women were never taught this: your pelvic floor muscles need to be able to lengthen and accommodate the speculum during the exam.

The good news is that there are practical steps you can practice ahead of time to help you understand the process and feel more prepared.

First, Understand How a Speculum Works

A speculum can look pretty intimidating if you have never actually seen one.

During a Pap smear, the speculum is inserted vaginally and then opened to create enough space for your healthcare provider to perform the exam.

That means your pelvic floor muscles need to be able to lengthen and accommodate both the insertion and the opening of the speculum.

Cleveland Clinic also explains how speculums work, the different sizes available, and why some women may experience discomfort during an exam:

https://my.clevelandclinic.org/health/articles/24238-speculum

One of the first things I recommend is purchasing a small, plastic child-sized speculum.

Even before you use it, simply hold it.

Look at it.

Learn how it opens and closes.

Understanding what is actually being inserted into your body can take away some of the mystery surrounding the exam.

Start Smaller With a Tampon Applicator

Before practicing with a speculum, start with something smaller.

If insertion is uncomfortable, begin with a slim tampon applicator.

Once that feels comfortable, progress to:

  1. A slim tampon applicator
  2. A regular tampon applicator
  3. A super-size tampon applicator
  4. A child-sized speculum

The goal is to gradually become more comfortable with insertion rather than immediately jumping to the largest tool.

Practice Pressing “Around the Clock”

Once the tampon applicator is inserted comfortably, practice applying gentle pressure around the vaginal opening.

Think of the opening like the face of a clock.

You can gently explore different directions around that clock to help your pelvic floor become more comfortable accommodating pressure from different angles.

Once the smaller applicator feels comfortable, move up gradually through the different sizes.

You do not need to rush.

Get Comfortable With the Speculum Before Opening It

Once you feel comfortable using the tampon applicators, you can begin practicing with the child-sized speculum.

Start by simply practicing insertion and removal.

Before trying to open it while it is inserted, practice the mechanism with the speculum outside of your body.

Learn how it clicks open.

Learn how to release it.

Practice operating it from the same angle it would be positioned during a pelvic exam.

The goal is to understand exactly how the tool works so there are fewer surprises.

Try the One-Click Method

Once insertion feels comfortable and you understand how the mechanism works, Pauli recommends progressing gradually.

Insert the lubricated child-sized speculum slowly.

Then give it one click open.

Allow yourself a moment to adjust to that sensation.

Then release the click and slowly remove the speculum.

You do not need to immediately open it to its full capacity.

This gradual practice gives you more control over the experience and allows you to work at your own pace.

Put Yourself in the Driver’s Seat

One of the biggest benefits of preparing ahead of time is that you understand what feels comfortable for your body.

Pauli shares that many of her patients in Utah have brought their own child-sized speculum to their medical appointments.

Some doctors have been willing to use the smaller speculum, and some have even allowed the patient to insert or open the speculum herself.

That can be especially meaningful for women who have a history of trauma or who feel anxious about pelvic exams.

Instead of feeling like everything is happening to you, you can have more input into:

  • The pace of the exam
  • Your comfort level
  • How much time you need
  • The size of the speculum
  • When you are ready to proceed

A Pap smear is important.

But that does not mean you have to completely give up control of your body during the process.

Talk to Your Healthcare Provider

At your appointment, communicate what you need.

You can tell your provider that you have pelvic floor tightness or a history of painful exams.

If you have practiced with a smaller speculum and would like your provider to use it, ask whether they are comfortable doing so.

You may also need a little extra time before the exam begins.

The important thing is that you communicate rather than silently trying to endure discomfort.

Understanding your body creates confidence.

You Do Not Have to Figure This Out Alone

If these steps still feel intimidating or scary, that is important information too.

You do not need to force yourself through the process alone.

A pelvic floor physical therapist can help you work through insertion, pelvic floor relaxation, and preparation for a speculum exam in a more supported setting.

A painful speculum exam does not have to be something you simply dread every time your next Pap smear approaches.

Preparation can help you understand what is happening, become more familiar with the tools involved, and feel more in control of your body.

If you’re tired of conflicting advice online and want a clear roadmap, explore the No Kegels University® Method and learn how to build lasting strength and confidence.

Complete Your Pelvic Floor’s Next Step Form here:

https://www.beyondthevbypauli.com/nextstep

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Signs of Endometriosis: When Period Pain May Be More Than “Bad Cramps”

For generation after generation, women have been handed a dangerous piece of advice: “Heavy, painful periods are just your cross to bear as a woman.” We are told to take an over-the-counter pain reliever, push through the day, and keep going.

Most women were never taught this, but debilitating period pain that leaves you stuck in bed, missing work, or curling up in a hot bath just to survive is not normal. When you are constantly pushing through agonizing cycles, it’s easy to assume your body is just overreacting. Understanding your body creates confidence. Your pain is real, your symptoms are valid, and you do not have to just accept a life dictated by an unpredictable cycle.

What Is Endometriosis?

To understand why this pain occurs, we have to look at what is happening inside the pelvic cavity.

Endometriosis is a systemic condition where tissue similar to the lining of the uterus (the endometrium) grows outside of the uterus. These abnormal growths are called lesions. They can embed themselves anywhere within the pelvic and abdominal cavities—on the ovaries, the fallopian tubes, the outer wall of the intestines, or even the bladder.

Just like the lining inside your uterus, these external lesions respond to your monthly hormonal changes. They swell and bleed every single month. However, because this blood is trapped inside your pelvic cavity with no way to exit the body, it creates chronic, low-grade inflammation and deep tissue irritation.

Pregnancy and Birth Control Do Not “Cure” Endo

The single most common piece of misinformation handed to women with severe menstrual pain is that getting pregnant or taking hormonal birth control pills will cure the condition.

The Medical Fact: While birth control pills can sometimes chemically suppress or mask your symptoms by halting a regular cycle, they do not dissolve or eliminate the underlying lesions. Similarly, while pregnancy offers a temporary hormonal shift, it is absolutely not a cure.

Another common myth is that if your pain is felt in your hips or lower back, it must be a strictly orthopedic issue. Endometriosis lesions frequently irritate the complex network of pelvic nerves, referring sharp, debilitating pain directly into your hips, glutes, and thighs.

The Pelvic Floor and Scar Tissue Superglue

Why does endometriosis cause such widespread dysfunction? It comes down to a root-cause issue of cellular inflammation and scar tissue development.

When endometrial lesions bleed into the pelvic cavity month after month, your body tries to protect itself by walling off the irritated areas. It does this by laying down dense layers of scar tissue and adhesions. This scar tissue acts exactly like internal superglue, causing organs that should naturally slide, glide, and shift past one another to become bound tightly together.

According to clinical information from Mayo Clinic, this persistent internal inflammation and structural binding impacts neighboring muscle groups. In nearly 100% of endometriosis cases, the pelvic floor muscles become intensely involved. The deep pelvic muscles go into a protective, hypertonic spasm—a state of chronic over-contraction. This secondary pelvic floor dysfunction is often the hidden driver behind painful intimacy, lower back stiffness, and deep pelvic aching between periods. Root-cause healing matters, and you cannot resolve a structural, inflammatory issue with generic advice.

Action Steps: Navigating Your Symptoms

If you suspect your severe symptoms are pointing toward endometriosis, you deserve an organized approach to advocate for your health:

  1. Document Your Pain Patterns: Keep a detailed daily symptom log for at least two full cycles. Note not just the days you bleed, but the specific location of your pain (e.g., lower right abdomen, deep back ache) and how it affects activities like running, bending, or using a tampon.
  2. Track the Internal Clues: Watch for secondary inflammatory signs. Do you experience heavy clotting during your period? Do you experience deep pelvic aching during or immediately after intimacy?
  3. Screen Your Pelvic Floor Coordination: Notice if you are constantly gripping your core or holding your breath to protect against abdominal discomfort. Chronic gripping tightens the pelvic floor, compounding your pain.
  4. Assemble a Dedicated Care Team: Seek out providers who specialize specifically in complex pelvic health. You need professionals who look at your body as an interconnected system rather than isolated parts.

Your body is not broken. Pushing through excruciating monthly cycles without answers is incredibly frustrating, but there is a distinct difference between “common” and “normal.” This is about more than symptom management. It is about mapping out a precise path toward structural comfort and physical freedom.

If you are tired of conflicting advice online and want a clear roadmap, explore the No Kegels University® Method and learn how to build lasting strength and confidence. Take a step toward targeted care and fill out Your Pelvic Floor’s Next Step Form today to begin addressing the true root causes of your pelvic health.

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Endometriosis Flare: What Is Your Body Trying to Tell You?

If you live with endometriosis, you know the feeling.

You wake up expecting a normal day, and within a few hours, everything changes.

The pain increases.

Your energy disappears.

Simple tasks suddenly feel overwhelming.

Maybe your first thought is, “Not again.”

I’ve been there.

As someone who has lived with endometriosis, I know how discouraging flares can be. They can interrupt work, family time, exercise, travel, and even the plans you’ve been looking forward to all week.

It’s easy to feel frustrated with your body during those moments.

But over the years, I’ve learned something that completely changed the way I approach a flare.

Instead of asking, “Why is my body doing this to me?”

I started asking,

“What is my body trying to tell me today?”

That one question shifted everything.

Your body is not broken.

Learning to listen to your body doesn’t mean giving in to your symptoms. It means responding with curiosity instead of frustration and making choices that support healing instead of working against it.

Your Body Is Always Communicating

Our bodies are incredibly intelligent.

They constantly communicate through signals like:

  • Hunger
  • Thirst
  • Fatigue
  • Pain
  • Muscle tension
  • Energy levels

Pain is one of those signals.

It isn’t always pleasant, but it is information.

When an endometriosis flare begins, your body is telling you that something needs your attention.

That doesn’t mean you’ve done something wrong.

It doesn’t mean your body is failing you.

It simply means your body has different needs today than it did yesterday.

Most women were never taught this.

Stop Fighting the Flare

One of the hardest lessons I’ve had to learn is that fighting my body usually makes things harder.

When symptoms first started years ago, my instinct was to ignore them.

I’d tell myself:

“Just push through.”

“You’ll feel better later.”

“You don’t have time to slow down.”

Sometimes that worked—for a little while.

But eventually, my body always demanded my attention.

The more I resisted, the more exhausted I became.

Eventually, I realized something.

Listening to my body wasn’t weakness.

It was wisdom.

The goal isn’t temporary relief—it’s long-term strength.

Ask Yourself One Simple Question

When a flare starts, I encourage women to pause and ask themselves:

“What do I need today?”

Notice I didn’t say:

“What should I be doing?”

Or,

“What did I do wrong?”

Instead, ask what your body actually needs in this moment.

The answer will look different every time.

Maybe today your body needs:

  • More water
  • A nourishing meal
  • A short walk
  • Gentle stretching
  • A nap
  • A heating pad
  • Quiet time
  • Deep breathing

There isn’t one right answer.

The key is learning to respond instead of react.

Understanding your body creates confidence.

Sometimes Rest Is the Right Choice

There is a misconception that resting means you’re giving up.

I don’t believe that.

Rest is one of the ways your body heals.

If you’re completely exhausted, forcing yourself through an intense workout or a packed schedule may not help your recovery.

Instead, ask yourself:

“Will this help my body heal today?”

Sometimes the answer is yes.

Sometimes the answer is no.

Giving yourself permission to rest without guilt can be one of the healthiest decisions you make.

Other Times, Your Body Needs Gentle Movement

Listening to your body doesn’t always mean staying in bed.

Sometimes your body needs movement.

During a flare, gentle movement may help reduce stiffness, improve circulation, and keep your muscles from becoming more guarded.

That movement might include:

  • A slow walk around the neighborhood
  • Gentle stretching
  • Deep breathing exercises
  • Light mobility work

It doesn’t have to be intense to be beneficial.

The Mayo Clinic explains that endometriosis symptoms vary from woman to woman, which is why treatment and self-care often need to be individualized. Learning how your own body responds to activity can help you make more informed decisions during a flare.

Root-cause healing matters.

Nourishment Matters More Than You Think

During a flare, it’s easy to forget the basics.

You may not feel like eating.

You may forget to drink enough water.

Or maybe you’re so focused on managing pain that nutrition falls to the bottom of the list.

But your body is working hard.

Supporting it with nourishing foods, hydration, and adequate rest gives it the resources it needs to recover.

Healing isn’t about doing one big thing.

It’s about doing many small things consistently.

Be Curious Instead of Critical

It’s easy to criticize yourself during difficult seasons.

You may think:

“I should be doing more.”

“Why can’t my body just cooperate?”

“I’m falling behind.”

Instead, try replacing criticism with curiosity.

Ask questions like:

  • What made this flare different?
  • Have I been getting enough sleep?
  • Am I carrying more stress than usual?
  • Have I been fueling my body well?
  • What helped me feel better the last time?

You’re gathering information—not assigning blame.

That shift changes the entire conversation you have with your body.

Healing Doesn’t Look the Same Every Day

One of the biggest mistakes we make is expecting consistency from a condition that isn’t always consistent.

Some weeks you’ll feel great.

Other weeks will be harder.

That doesn’t mean you’re moving backward.

Healing is rarely a straight line.

The National Institutes of Health (NIH) notes that endometriosis is a chronic condition with symptoms that can vary significantly over time, reinforcing the importance of creating a personalized management plan rather than expecting every day to look the same.

When you stop measuring success by whether you had symptoms and start measuring success by how you cared for yourself during those symptoms, your perspective begins to change.

You Are More Than Your Diagnosis

Endometriosis is part of your story.

It is not your identity.

Yes, there will be difficult days.

But there will also be joyful days.

Days where you laugh.

Move.

Connect with people you love.

Celebrate milestones.

Experience peace.

Don’t let your diagnosis convince you that your future is limited.

You deserve better than fear-based advice that tells you your body is working against you.

Your body is doing the best it can.

And every day, you have an opportunity to respond with compassion instead of frustration.

Your Next Step

If you’re tired of feeling like every flare is a setback, you don’t have to navigate this journey alone.

Start by filling out Your Pelvic Floor’s Next Step Form so we can better understand your symptoms, identify patterns, and create a plan that’s personalized to your body and your goals.

👉 https://www.beyondthevbypauli.com/nextstep

If you’re looking for a step-by-step approach to understanding your body, managing endometriosis, and building lasting strength, explore the No Kegels University® Method.

Healing isn’t about perfection.

It’s about understanding, consistency, and progression.

The next time a flare begins, remember this:

Instead of asking, “Why is this happening to me?”

Try asking,

“What is my body trying to tell me today?”

That simple shift may become one of the most powerful tools in your healing journey.

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Pelvic Floor Physical Therapy for Endometriosis: How It Can Help

One of the most common questions women ask is:

“If pelvic floor physical therapy doesn’t treat endometriosis, why would it help my symptoms?”

It’s a fair question.

Because most of the time, endometriosis is talked about as something that exists only in the uterus or pelvic organs.

So it makes sense to wonder why working with muscles, breathing, and movement would matter.

But what many women discover is this:

Their pain is not coming from just one place.

And their healing doesn’t have to either.

Your body is not broken.

Let’s talk about what’s actually going on.

Endometriosis Is More Than a Tissue Problem

Endometriosis is often described as tissue similar to the uterine lining growing outside the uterus.

But the symptoms women experience are rarely just from the tissue itself.

Pain is also influenced by:

  • Inflammation
  • Adhesions or scar tissue
  • Muscle guarding
  • Nervous system sensitivity
  • Changes in movement patterns

The Cleveland Clinic explains that endometriosis can lead to chronic pelvic pain due to inflammation and irritation of surrounding structures—not just the lesions themselves.

This is where the pelvic floor becomes a major part of the picture.

The Pelvic Floor Responds to Everything Happening in the Pelvis

Your pelvic floor muscles sit at the base of your pelvis and support your bladder, uterus, and rectum.

They are constantly adapting to what is happening above them.

So when there is:

  • Ongoing pain
  • Inflammation
  • Surgical history
  • Limited movement
  • Fear of movement

Your pelvic floor often responds by tightening or guarding.

This is not random.

It is protective.

But over time, protection can turn into dysfunction.

That’s when symptoms begin to show up as:

  • Pelvic pain
  • Pain with intimacy
  • Constipation
  • Bladder urgency or frequency
  • A feeling of tightness or pressure
  • Difficulty relaxing

Understanding this connection is one of the first steps toward meaningful healing.

Understanding your body creates confidence.

Why Pelvic Floor Physical Therapy Helps (Even Without Treating Endometriosis)

Pelvic floor physical therapy does not remove endometriosis.

It does not replace medical or surgical care.

But it does something equally important:

It helps your body function better around the pain.

This is where real change begins.

The https://www.aptapelvichealth.org/ supports pelvic health physical therapy as an evidence-informed approach for treating pelvic floor dysfunction and chronic pelvic pain conditions often seen alongside endometriosis.

Here’s how it helps.

1. It reduces pelvic floor guarding

When your body has been in pain for a long time, your muscles often stay slightly “on” all the time.

They are trying to protect you.

But constant protection becomes tension.

Pelvic floor physical therapy helps:

  • Teach muscles how to relax again
  • Reduce overactivity
  • Improve coordination
  • Break the pain–tension cycle

This is not about forcing relaxation.

It’s about retraining safety into the system.

2. It restores the core–pelvic floor connection

Your diaphragm, deep core, and pelvic floor work together every time you breathe and move.

When pain, surgery, or inactivity disrupts this system, symptoms can increase.

You may notice:

  • Shallow breathing
  • Core weakness or instability
  • Avoidance of movement
  • Increased pelvic tension

PT helps retrain this coordination so your body can function as a connected system again.

This matters more than most women are ever told.

3. It calms the nervous system

Pain is not just a structural issue—it is a nervous system experience.

When pain persists, your body becomes more protective over time.

That can lead to:

  • Increased sensitivity
  • Muscle guarding
  • Fear of movement or intimacy
  • Feeling like your body is “on alert”

Pelvic floor physical therapy uses:

  • Gentle movement
  • Breathwork
  • Gradual exposure to activity
  • Education and reassurance

to help your system shift out of protection and back into safety.

This is where symptoms often begin to change.

4. It rebuilds trust in your body

This may be the most important part.

Many women with endometriosis begin to feel like their body is unpredictable or unreliable.

They stop exercising.

They avoid intimacy.

They fear symptoms returning.

But when you begin to understand what your body is doing—and why—it changes everything.

You begin to realize:

  • Movement is not dangerous
  • Pain does not always mean damage
  • Your body is adaptable
  • Healing is possible, even with endometriosis

This is about more than symptom relief.

It is about rebuilding confidence in your body.

Myth: PT Only Helps After Surgery

Pelvic floor physical therapy is often misunderstood as something you only do after surgery.

But it can be helpful at every stage:

  • Before diagnosis
  • After diagnosis
  • Before surgery
  • After surgery
  • Alongside medical treatment

Because it is not focused on the disease itself.

It is focused on how your body is functioning.

Root-cause healing matters.

What This Means for You

If you are living with endometriosis and experiencing:

  • Pelvic pain
  • Pain with intimacy
  • Bladder or bowel changes
  • Tightness or pressure
  • Difficulty exercising
  • Ongoing unexplained discomfort

Your pelvic floor may be playing a much larger role than you’ve been told.

And the encouraging part is:

This is something you can work on.

Not by pushing harder.

But by retraining how your body moves, responds, and functions over time.

Your Next Step

If you are struggling with endometriosis symptoms and want clarity on what is driving your pelvic pain, you do not have to figure it out alone.

Start by filling out Your Pelvic Floor’s Next Step Form so we can help you understand your body and identify your best next step.

https://www.beyondthevbypauli.com/nextstep

If you are ready for a structured approach to rebuilding core and pelvic floor strength without relying on endless Kegels, explore the No Kegels University® Method.

Healing is not about perfection.

It is about understanding, consistency, and progression.

Your body is capable of adaptation, strength, and change—even with endometriosis.

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Pelvic Floor Breathing Exercises: How Balloon Breathing Helps You Relax

When you are managing a chronic pelvic condition, your body can easily get trapped in a state of high alert. Constant physical discomfort can make your breathing shallow, your posture tense, and your baseline stress levels skyrocket. Before you know it, you are preferring to head to bed early to just try and sleep through the discomfort rather than enjoying your life.

Most women were never taught this, but chronic pain can change how you breathe and how your body holds tension. You deserve better than generic advice that tells you to simply “relax” without giving you the physical tools to do so. Learning how to direct your breath into your lower abdomen can be a simple, effective way to calm your nervous system and restore natural movement to your pelvic floor.

The Power of Three-Dimensional Breathing

Standard breathing advice usually focuses entirely on filling your lungs and expanding your upper chest. While that keeps you oxygenated, it can leave out what is happening through your abdomen and pelvic floor.

To safely manage internal tension, think of your torso as a three-dimensional chamber. When you take a deep inhale, your diaphragm—the large muscle sitting right under your ribs—descends downward. As it drops, the structures below it respond to that movement.

This creates a natural, responsive pressure change that reaches all the way to the base of your pelvis, allowing your pelvic floor muscles to gently stretch, drop, and lengthen. When you exhale, the system reverses and the pelvic floor naturally recoils.

Belly Breathing vs. Chest Breathing

A massive misconception across general fitness and women’s wellness is that a flat, rigid, tucked-in stomach is a sign of a healthy, functioning core.

The Breathing Fact: Constantly gripping or sucking in your abdominal muscles can interfere with relaxed diaphragmatic breathing and may contribute to increased pelvic floor tension.

Many people also believe that therapeutic pelvic floor exercises always have to involve active, forceful contractions like Kegels.

In reality, if your pelvic muscles are already tight or guarded, adding more forceful contractions may not be what your body needs and can sometimes aggravate symptoms.

Shifting Out of the Fight-or-Flight Lock

Why can shallow breathing and stress make pelvic symptoms feel worse?

It comes down to the relationship between your nervous system, your breathing, and the way your muscles hold tension.

When you experience ongoing pelvic discomfort, or navigate a complex postpartum recovery, your nervous system may become more protective and alert. Your abdomen, hips, and pelvic floor may begin holding additional tension as part of that protective response.

Over time, that guarding can contribute to symptoms associated with a tight or overactive pelvic floor.

Diaphragmatic breathing can support relaxation and help your pelvic floor practice moving through a fuller range instead of remaining constantly guarded.

APTA Pelvic Health explains how diaphragmatic breathing and pelvic floor relaxation can be used together to help reduce pelvic floor muscle tension.

https://www.aptapelvichealth.org/info/relaxation-of-the-pelvic-floor-muscles

Root-cause healing matters, and learning better breathing mechanics can be one useful tool for helping your body shift toward a calmer, more relaxed state.

How to Practice Balloon Breathing

To help your nervous system let go of some of its protective tension and restore natural movement through your pelvic floor, try practicing this balloon visualization method:

  1. Visualize the Internal Balloon: Lie down comfortably on your back or side. Imagine there is a soft balloon sitting deep inside your lower abdomen, right between your hip bones.
  2. Fill the Balloon Symmetrically: Take a slow, quiet inhale through your nose. Instead of letting all of the movement happen in your upper chest, focus on filling that internal balloon. Imagine it expanding three-dimensionally—stretching the front of your belly, widening into your sides, pressing gently into your lower back, and expanding down toward the bottom of your pelvis.
  3. Monitor the Lower Abdomen: Place a hand between your belly button and your pubic bone. Notice whether this lower section gently rises along with your upper belly rather than remaining completely flat or rigid.
  4. Allow a Passive Pelvic Drop: As you fill the bottom of the balloon, imagine your pelvic floor softly dropping and lengthening away from your ribs. Exhale slowly and comfortably, letting the balloon deflate naturally without forcing the air out.

The goal isn’t temporary relief—it’s long-term strength.

True pelvic wellness means giving your body the space and permission to let go of unnecessary guarding. By practicing three-dimensional balloon breathing, you can support your nervous system, improve your breathing and pelvic floor coordination, and become more connected to what your body is doing.

You don’t need more generic core workouts.

You need a strategy that respects your symptoms, your boundaries, and your individual goals.

If chronic pelvic floor tightness is affecting your daily life, fill out Your Pelvic Floor’s Next Step Form so we can help determine what kind of support may be right for you:

https://www.beyondthevbypauli.com/nextstep

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Exercise for Pelvic Pain: What to Do During a Flare

When you are in the middle of a severe pelvic pain flare-up, the absolute last thing you want to hear someone say is, “You just need to go exercise.” When your lower abdomen feels like it is in a vice grip, your natural instinct is to curl up, stay as still as possible, and wait for the wave of discomfort to pass.

If you have tried traditional workouts in the past only to end up in more pain, it is completely normal to feel frustrated or hesitant. Most women were never taught this, but there is a massive difference between exhausting fitness routines and restorative, therapeutic movement.

You deserve better than fear-based advice that tells you to completely lock down your body. Moving safely is entirely possible, and gentle movement can be a helpful tool for improving comfort during a pelvic flare.

The Physiology of Restorative Movement

To understand why the right kind of movement can help, we have to look at what happens when the body stays tight and guarded.

When a specific area of the body experiences chronic irritation or pain, the surrounding muscles may tighten protectively. Gentle, low-intensity movement that does not provoke pain can help increase circulation, reduce stiffness, and encourage your body to move more comfortably.

Movement can also support the release of endorphins—your body’s natural pain-relieving chemicals.

The goal is not to force movement through pain.

It is to introduce enough comfortable movement to remind your body that it does not have to stay completely rigid.

Exercise Doesn’t Have to Mean Sweating

The biggest misconception in general fitness and women’s wellness is the belief that a movement session only “counts” if it leaves you sweating, breathless, and completely exhausted.

The Movement Fact: During a pelvic pain flare, higher-intensity exercise may aggravate symptoms for some women. Gentle, low-load movement may be a better place to start.

Another common myth is that complete, prolonged bed rest is always the best way to recover from a pelvic pain flare.

There may absolutely be moments when rest is what your body needs.

But prolonged inactivity can sometimes contribute to increased stiffness and discomfort.

Movement during a flare does not need to look like a traditional workout.

Sometimes it simply means helping your body move in a way that feels safe.

Unlocking the Pelvic Guarding Reflex

Why can movement sometimes make pelvic symptoms feel better?

It comes down in part to your body’s natural protective response.

When you are experiencing pelvic pain from a condition like endometriosis, or when your body is recovering during the postpartum period, the muscles around your pelvis may begin guarding.

Your core, hips, and pelvic floor may hold more tension in an attempt to protect an area that feels painful or irritated.

Over time, that guarding can contribute to additional tightness and discomfort.

APTA Pelvic Health explains that pelvic floor physical therapy for pelvic pain may include individualized exercises, stretching, breathing techniques, relaxation, and other strategies designed to improve pelvic floor function and comfort.

https://www.aptapelvichealth.org/info/pelvic-pain-causes-symptoms-physical-therapy-treatment

When you introduce strategic, pain-free pelvic floor exercises and intentional mobility work, you may help improve flexibility, coordination, and comfort within those guarded tissues.

Root-cause healing matters, and sometimes helping a guarded pelvic floor relax means gradually reintroducing comfortable movement instead of remaining completely still.

Action Steps: Moving Safely Through a Flare

If you want to use intentional movement to manage your symptoms without pushing your body too hard, start with this progressive approach:

  1. Reframe the Concept of a Workout: Shift your vocabulary away from intense “exercise” and focus instead on “pain-free joint and tissue mobility.”
  2. Utilize Low-Load Pelvic Floor Exercises: Practice gentle pelvic drops and diaphragmatic breathing from comfortable, supported positions—such as lying on your back with your legs resting on a chair—to encourage relaxation through the pelvic floor.
  3. Listen to the Pain-Free Boundary: Move your hips, back, and torso only through ranges of motion that feel smooth and comfortable. If an angle causes a sharp pinch, increased pain, or a protective catch in your breath, back off.
  4. Track Your Post-Movement Comfort: Pay attention to how you feel 30 to 60 minutes after moving. If you notice less stiffness, easier movement, or a reduction in your baseline discomfort, that may be a useful sign that the intensity was appropriate for your body.

The goal isn’t temporary relief—it’s long-term strength.

Reclaiming your physical confidence means learning how to work with your body’s signals rather than fighting against them.

You do not have to let a pelvic pain flare trap you in a cycle of fear, stiffness, and restriction.

You don’t need more random fitness programs.

You need a strategy that respects your symptoms, your boundaries, and what your body is communicating.

If you’re dealing with recurring pelvic pain or aren’t sure what kind of movement is right for you, working with a pelvic floor physical therapist can help you understand what is contributing to your symptoms and create a plan specifically for your body.

Complete Your Pelvic Floor’s Next Step Form to begin creating a personalized path forward:

https://www.beyondthevbypauli.com/nextstep

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Hip Pain and Painful Periods? The Hidden Connection You Need to Know

If you are a runner, an active mom, or simply a woman trying to navigate your daily life, dealing with chronic, stubborn hip pain can be incredibly frustrating. You try stretching, you try rest, and you might even go to traditional physical therapy, yet the deep ache in your hip never seems to fully go away.

At the same time, maybe you struggle with excruciatingly painful periods, dread placing tampons, or experience intense cramping every month.

Like most women, you probably view these as two completely separate issues. You treat your hip pain with ice and ibuprofen, and you treat your menstrual pain with a heating pad, assuming they have nothing to do with each other.

I am so sorry to tell you, but you may have been given incomplete information.

As a pelvic floor physical therapist, I hear stories like this every single day. Women spend years bouncing from orthopedists to gynecologists, trying to fix isolated symptoms. But most women were never taught this: your hips and your pelvic organs are closely connected within the same region of the body.

If you’ve been told that your pain is just something you have to live with, please hear me: your body is not broken. Your symptoms may not be as random or disconnected as they seem.

The Intersection of Orthopedics and Pelvic Health

To understand how pelvic issues can sometimes show up alongside orthopedic pain, we have to look at the anatomy of your pelvis.

Growing up with a physician father and a nurse mother, I knew early on that I wanted to make a big difference in the healthcare world. When I was in middle school, I developed severe knee and hip pain from running track. It hurt to walk, and it even hurt to sleep. That pain drove me to my very first physical therapy experience, and it sparked a lifelong passion for understanding human movement.

But it wasn’t until after high school, while working as a physical therapy aide, that the puzzle pieces of my own health began to connect.

I was running regularly and dealing with persistent, nagging hip pain. One afternoon, a newly graduated physical therapist sat down with me and started asking questions that felt incredibly personal and, honestly, a little inappropriate at the time.

She asked:

  • Are your periods painful?
  • Is it painful for you to insert tampons?
  • Do you suffer from severe abdominal cramping?

I answered yes to every single question.

She looked at me and said, “I don’t think this is just a running injury. I think you have endometriosis.”

Years later, endometriosis was confirmed through surgery, and it became clear that the condition could help explain some of the hip and pelvic pain I had been experiencing.

For more information about endometriosis symptoms and causes, Mayo Clinic offers a helpful overview:

https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656?utm_source=chatgpt.com

Myth-Busting: “Hip Pain Is Always a Joint or Muscle Issue”

The biggest myth keeping active women stuck is the idea that if your hip hurts, the problem must live exclusively in your hip joint, glutes, or IT band.

The Reality: Your hips and pelvic floor exist in the same interconnected region of your body.

The muscles that rotate your leg and stabilize your pelvis attach throughout the pelvic girdle and sit close to the pelvic floor and internal pelvic structures.

Conditions that create pelvic pain, inflammation, or irritation may also contribute to protective muscle guarding and changes in how the muscles around your hips and pelvic floor function.

That means hip pain does not always have to be viewed as an isolated hip problem.

You deserve better than fear-based advice that tells you to stop running, stop lifting, or simply accept painful cycles.

Root-cause healing matters, and sometimes getting better answers means looking at both your orthopedic symptoms and your pelvic health instead of treating them as completely unrelated.

Why Internal Tension Can Affect External Pain

When your body experiences pelvic pain or pelvic floor dysfunction, your muscles may respond by tightening or guarding.

Because the pelvic floor and deep hip muscles work so closely together, pelvic floor tension can contribute to hip tightness, discomfort, or changes in movement.

This may affect things like:

  1. How comfortable your hip feels when you walk, run, squat, or exercise.
  2. How easily your pelvic floor muscles are able to relax and lengthen.

Pelvic floor tension itself is not necessarily the cause of painful periods. But if you already experience pelvic pain, endometriosis, or painful menstrual cycles, muscle guarding may be another piece of the overall picture.

This is about more than symptom management.

If you only focus on the hip without considering what else may be happening in your pelvis, you could miss an important part of the story.

Understanding your body creates confidence, and recognizing that pelvic health can influence how your hips feel and move may help you ask better questions and find more complete care.

Practical Action Steps for Dual Healing

If you are dealing with both hip pain and pelvic symptoms, here are a few places to start.

1. Track Your Pain Patterns

For one or two menstrual cycles, keep a simple journal.

Notice:

  • When your hip pain increases
  • When your period begins
  • Whether your hip feels worse before or during your period
  • Whether you experience painful tampon insertion
  • Whether you also notice abdominal or pelvic cramping

If your hip symptoms consistently change around your menstrual cycle, that pattern may suggest there is a pelvic or menstrual component worth discussing with a provider.

2. Give Your Hips and Pelvic Floor Room to Relax

If your body already feels tight and guarded, aggressive clenching exercises may not always be what you need.

Gentle positions such as a wide-legged child’s pose or comfortable hip-opening stretches may help you explore relaxation through the hips and pelvic floor.

The goal isn’t to force a stretch.

It is to give your body space to move and relax without adding more tension.

3. Work With a Pelvic Floor Physical Therapist

If you are dealing with hip pain and symptoms like painful periods, pelvic pain, painful tampon insertion, or pain with intimacy, a pelvic floor physical therapist can help look at the bigger picture.

Instead of only treating the hip, pelvic floor physical therapy can evaluate how your hips, pelvic floor, movement patterns, and symptoms may be interacting.

If this sounds like what you’ve been experiencing, you don’t have to keep guessing. Fill out your next step form today: https://www.beyondthevbypauli.com/nextstep

Claim Your Strength and Value

Your body was beautifully and intricately designed.

You do not have to settle for unexplained pain or feel embarrassed about seeking help for symptoms that involve your period, pelvic floor, or intimacy.

The goal isn’t temporary relief—it’s long-term strength.

You have immense worth, and taking care of your physical foundation is a meaningful part of honoring that worth.

Remember, you are an heiress and a queen and everything in between.

You deserve to live, move, and thrive in a body that feels secure, comfortable, and strong.

You don’t need more random exercises. You need a strategy. Book an appointment and let’s create a plan designed specifically for your body and goals.

Not sure what your body needs next? Complete Your Pelvic Floor’s Next Step Form:

Pelvic Floor Next Step
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Endometriosis and Pain With Sex: Why Your Pelvic Floor May Be Involved

Do you have endometriosis and experience pain with sex?

If you’ve been wondering why intimacy hurts, you are not alone.

As a women’s health physical therapist, one of the things I want women to understand is that endometriosis can affect the way structures inside the pelvis move.

Most women were never taught this.

And when those structures cannot move the way they are supposed to during intimacy, pain can become part of the experience.

How Endometriosis Can Affect Movement Inside the Pelvis

One of the things we know about endometriosis is that it creates lesions that can be black, tarry, and sticky.

These lesions can be found on different structures throughout the body, including:

  • The bladder
  • The uterus
  • Ligaments
  • Other areas inside the pelvis

They have even been found in other areas of the body.

The important piece when we’re talking about pain with intercourse is this:

Where those lesions are located can affect how well the organs and tissues around them move.

Your body is designed to move internally.

Your organs are not supposed to stay completely fixed in one position.

During intimacy, that movement matters.

Mayo Clinic notes that endometriosis can cause pain during or after sex and may also lead to scar tissue and adhesions that cause pelvic tissues and organs to stick together.

Learn more from Mayo Clinic about endometriosis

What Happens During Arousal

As the female body becomes aroused, the uterus lifts and pulls away from the vaginal canal.

This is not a huge movement, but it is still an important part of how the body prepares for intercourse.

If the uterus has lesions on it, or if lesions on the bladder, ligaments, or ovaries limit how those structures move, the uterus may not be able to shift as freely.

The body is trying to do what it is supposed to do.

But if that movement is restricted, dysfunction can occur.

And that dysfunction can contribute to pain.

The Pelvic Floor Connection

The pelvic floor also plays an important role during intercourse.

The pelvic floor muscles need to part and accommodate during penetration.

That allows space for a penis, finger, or other form of penetration.

If those muscles are not functioning well because of what is happening in the structures above them, they may not be able to do their job as effectively.

Instead of comfortably making room for penetration, the system may become restricted.

That can contribute to pain with intimacy.

Why This Matters

For many women, this connection has never been explained.

They know they have endometriosis.

They know sex hurts.

But no one has helped them connect those two experiences through the way their internal tissues and pelvic floor function together.

Understanding what may be happening inside your body can help the symptoms feel less mysterious.

Understanding your body creates confidence.

What to Do Next

If you have endometriosis and pain with sex, consider working with a provider who understands both women’s health and pelvic floor function.

A pelvic floor physical therapist can help evaluate how your pelvic floor is functioning and whether it may be contributing to the pain you are experiencing.

If you’re local, schedule an appointment. If you’re not, look for a pelvic floor physical therapist in your area who can help you better understand what your body needs.

Your body is not broken.

Pain with intimacy deserves attention, answers, and support.

If you’re ready to stop guessing and start understanding your body, complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals.

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Endometriosis and Chronic Pain: Why “Nothing Is Wrong” Isn’t the Whole Story

If you have endometriosis, there’s a good chance you’ve experienced something frustrating—and unfortunately, incredibly common.

You’ve described your pain.

You’ve explained how it affects your daily life.

You’ve shared how it impacts your work, exercise, relationships, or intimacy.

And then you’ve heard something like:

“Your scans look normal.”

“We didn’t find much.”

“Everything looks fine.”

“Maybe it’s stress.”

For many women, these conversations leave them questioning their own experiences. They start wondering if they’re overreacting or imagining things.

But here’s what every woman with endometriosis needs to hear:

Your body is not broken. And your pain is real.

As a women’s health physical therapist, I see women who have spent years searching for answers. Some have been told that the amount of endometriosis found doesn’t seem severe enough to explain how much pain they’re experiencing.

The truth is that endometriosis and chronic pain are complex, and pain can involve much more than what appears on a scan or during surgery.

Understanding your body creates confidence, and understanding why pain occurs is often the first step toward finding a better path forward.

What Is Endometriosis?

Endometriosis is a condition in which tissue similar to the lining inside the uterus grows outside of the uterus.

It most commonly affects structures within the pelvis, including the ovaries, fallopian tubes, and surrounding pelvic tissues.

Common symptoms may include:

  • Painful periods
  • Chronic pain
  • Pain during or after intercourse
  • Lower back or abdominal pain
  • Pain with bowel movements or urination
  • Digestive symptoms
  • Fertility challenges

Mayo Clinic explains that endometriosis can irritate surrounding tissues and contribute to scar tissue and adhesions. These adhesions are bands of fibrous tissue that may cause pelvic tissues and organs to stick to one another. Pain during or after sex is also a common symptom of endometriosis. Mayo Clinic

Mayo Clinic: Endometriosis Symptoms and Causes

One of the confusing parts of endometriosis is that the amount of visible disease doesn’t always explain the entire pain experience.

That disconnect is where many women begin to feel dismissed.

Why “Nothing Is Wrong” Is Often the Wrong Conclusion

One of the biggest misconceptions surrounding endometriosis is the belief that more visible disease automatically means more pain.

Pain is much more complicated than that.

Chronic pelvic pain can involve several factors at once, including:

  • Endometriosis
  • Tissue irritation
  • Pelvic floor muscle tension
  • Connective tissue restrictions
  • Nerve irritation
  • Bladder or bowel conditions
  • Nervous system sensitivity
  • Stress and previous pain experiences

Mayo Clinic describes chronic pelvic pain as a complex condition that may have more than one contributing cause. In some cases, testing may not identify one single explanation for the symptoms. Mayo Clinic

Mayo Clinic: Chronic Pelvic Pain

When providers focus only on what can be seen on imaging or during surgery, they may miss other contributors to the pain experience.

The Missing Piece: Your Pelvic Floor

One of the most overlooked contributors to chronic pelvic pain is the pelvic floor.

The pelvic floor is a group of muscles at the bottom of your pelvis.

These muscles support your:

  • Bladder
  • Bowel
  • Uterus and other pelvic organs

They also contribute to:

  • Bladder and bowel control
  • Core stability
  • Sexual function
  • Movement
  • Pressure management

When endometriosis creates ongoing pain or irritation within the pelvis, the surrounding muscles may begin responding protectively.

Your body’s natural response to pain is often to guard the painful area.

Think about what happens when you hurt your back.

You don’t consciously decide to tighten every surrounding muscle.

Your body does it automatically to protect you.

The pelvic floor can respond the same way.

At first, this tension may serve a protective purpose.

But if pain continues for months or years, those muscles may begin having difficulty fully relaxing.

That can contribute to:

  • Chronic pelvic pain
  • Pain during intercourse
  • Tailbone pain
  • Hip or low back pain
  • Urinary urgency
  • Constipation
  • Feelings of pelvic tightness or pressure

Most women were never taught this.

Many don’t realize that the pelvic floor muscles themselves can become another piece of the chronic pain puzzle.

How Endometriosis Can Affect Tissue Movement

Your organs, ligaments, and connective tissues aren’t designed to remain completely rigid.

Your bladder fills and empties.

Your bowel moves.

Your reproductive organs and surrounding tissues shift as your body changes position.

Healthy movement requires tissues to glide against one another.

Endometriosis can sometimes contribute to inflammation, scar tissue, or adhesions that affect this normal mobility.

Instead of thinking of the organs as literally being covered in “sticky glue,” a more accurate picture is that fibrous adhesions may restrict normal movement between tissues.

Those restrictions may become another source of discomfort within an already sensitive pelvis.

And when surrounding tissues hurt, the pelvic floor may become even more protective.

This is about more than symptom management.

Root-cause healing matters.

Myth-Busting: “If Doctors Don’t See Much, the Pain Must Be in Your Head”

Let’s address one of the most harmful conclusions women with chronic pelvic pain can hear.

If testing doesn’t reveal a simple explanation for your pain, that does not mean the pain isn’t real.

Myth: Normal imaging means nothing is wrong

Reality: Chronic pelvic pain can involve muscles, nerves, connective tissues, the bladder, bowel, reproductive organs, and the nervous system.

Myth: Pain that seems “too severe” must be psychological

Reality: Pain is a real nervous system experience. Emotional stress can influence pain, but that does not make the physical experience imaginary.

Myth: Treating endometriosis should automatically eliminate every pelvic symptom

Reality: For some women, muscle guarding or other contributors may continue even after the underlying endometriosis has been treated.

APTA Pelvic Health notes that pelvic pain can involve pelvic floor muscle tightness or weakness, tender muscle areas, nerve involvement, scar tissue, and conditions affecting pelvic organs—including endometriosis. APTA Academy of Pelvic Health

You deserve providers who understand that women’s health and chronic pelvic pain can involve more than one system.

The Root Cause: Chronic Pain Can Create Chronic Protection

One of the most important things to understand about chronic pain is that the body adapts.

When pain continues, you may begin changing the way you move without realizing it.

Muscles may stay tense.

Breathing patterns may change.

Certain activities may become guarded.

Your nervous system may become more alert to sensations within the painful area.

For some women, the cycle may look something like this:

Step 1: Endometriosis contributes to pelvic irritation or pain

Step 2: The pelvic floor tightens protectively

Step 3: Persistent muscle tension creates additional discomfort

Step 4: Pain makes the nervous system increasingly protective

Step 5: The cycle becomes easier to trigger

This isn’t the exact progression for every woman.

But understanding the possibility of a pain-and-guarding cycle can help explain why symptoms may continue even when you’ve already tried treatments aimed at the endometriosis itself.

The goal isn’t temporary relief—it’s long-term strength, comfort, and function.

Action Steps if You’re Struggling With Chronic Pelvic Pain

1. Seek Specialized Care

Consider working with a pelvic floor physical therapist who understands endometriosis and chronic pelvic pain.

A pelvic health physical therapist can evaluate factors such as:

  • Pelvic floor muscle tension
  • Weakness
  • Coordination
  • Tender areas
  • Movement patterns
  • Breathing
  • Nerve involvement

Treatment should be individualized rather than based on one generic exercise plan. APTA Pelvic Health describes pelvic health physical therapy as a whole-person approach tailored to the patient’s symptoms, lifestyle, health history, and goals. APTA Academy of Pelvic Health

2. Pay Attention to Symptom Patterns

Notice:

  • When symptoms increase
  • Whether pain changes around your menstrual cycle
  • Which movements make symptoms worse
  • Whether intercourse or bowel movements trigger pain
  • Whether stress or fatigue changes your symptoms

Patterns can give your healthcare team valuable information.

3. Don’t Assume More Kegels Are the Answer

Pelvic floor dysfunction doesn’t automatically mean weakness.

If your muscles are already tight and guarding, repeatedly contracting them may not address the problem.

Some women need strengthening.

Others need relaxation and mobility.

Many need a combination of strategies.

4. Address the Whole System

Healing may involve more than treating one diagnosis.

Depending on your individual situation, care may involve:

  • Medical treatment for endometriosis
  • Pelvic floor physical therapy
  • Movement and exercise
  • Breathing and pressure management
  • Bowel and bladder support
  • Nervous system regulation
  • Pain education

Understanding your body creates confidence.

5. Keep Advocating for Yourself

If you feel dismissed, keep asking questions.

Look for providers who understand endometriosis, pelvic floor dysfunction, and chronic pelvic pain.

Your symptoms deserve thoughtful investigation.

You’re Not Alone

If you’ve been told that your pain doesn’t make sense, you’re not alone.

Many women with endometriosis feel frustrated when their symptoms don’t seem to match what providers can easily see.

But pain is complex.

The pelvis is complex.

Your pelvic floor, surrounding tissues, nervous system, bladder, bowel, reproductive organs, and movement patterns can all influence the way your body experiences pain.

Your body is not broken.

And your symptoms deserve more than another generic answer.

When we stop looking only at one structure and begin considering the entire system, we create more opportunities to understand what may actually be contributing to your pain.

Root-cause healing matters.

If you’re tired of conflicting advice online and want a clear roadmap, explore the No Kegels University® Method and learn how to build lasting strength and confidence.

Not sure what your body needs next? Complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals:

Your Pelvic Floor’s Next Step Form

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Why Endometriosis Causes Pain With Sex: The Pelvic Floor Connection

Do you have endometriosis and experience pain with sex?

If you find yourself constantly wondering why intimacy hurts so badly, you are not alone.

Many women with endometriosis spend years searching for answers. You may have tried medications, changed positions, used more lubricant, or simply tried to push through the discomfort because you didn’t know what else to do.

When intimacy becomes painful, it can affect far more than your physical body. You may begin worrying about your relationship, avoiding penetration, or wondering whether comfortable intimacy will ever be possible.

Please hear this first:

Your body is not broken.

Most women were never taught this: endometriosis can affect much more than your reproductive organs. It can influence surrounding tissues, create adhesions, contribute to chronic pelvic pain, and lead the pelvic floor muscles to become tense and protective.

This is about more than symptom management.

Understanding why endometriosis and pain with sex are connected can help you stop blaming yourself and start identifying the different pieces that may be contributing to your symptoms.

Why Endometriosis Can Cause Pain During Sex

Endometriosis is a condition in which tissue similar to the lining inside the uterus grows outside the uterus.

It may involve areas around the:

  • Ovaries
  • Fallopian tubes
  • Pelvic lining
  • Bowel
  • Bladder
  • Ligaments and tissues surrounding the reproductive organs

Mayo Clinic explains that endometriosis can irritate surrounding tissues and lead to scar tissue and adhesions—bands of fibrous tissue that can cause pelvic organs and tissues to stick together. Pain during or after sex is also a common symptom of endometriosis. Mayo Clinic

Why does this matter for intimacy?

Your pelvic organs and surrounding tissues aren’t designed to remain perfectly rigid. They need to move and adapt as your bladder fills, your bowel moves, your body changes position, and sexual arousal occurs.

If inflammation, adhesions, or areas of endometriosis restrict normal movement, deeper penetration may place pressure on already-sensitive tissues.

That can contribute to the deep aching, sharp, or pulling pain many women with endometriosis describe during intercourse.

What Happens to Your Body During Arousal?

During sexual arousal, your body undergoes several physical changes.

Blood flow to the genital tissues increases, the vagina becomes more lubricated, and the upper portion of the vaginal canal can lengthen and expand. The uterus may also move upward as part of this response.

Your body is creating more room for comfortable penetration.

But endometriosis can complicate the picture.

If tissues inside the pelvis are irritated, scarred, or restricted by adhesions, certain movements or deeper pressure may become uncomfortable.

That doesn’t mean every woman with endometriosis will experience painful sex.

And it doesn’t mean adhesions are the only possible cause.

Pain with sex can also involve the pelvic floor muscles themselves.

The Missing Piece: Your Pelvic Floor May Start Guarding

Your pelvic floor sits underneath the pelvic organs.

These muscles need to do two very different things well:

Contract when support is needed.

And relax and lengthen when you’re using the bathroom, inserting something vaginally, or having penetrative sex.

When pelvic pain continues for months or years, however, your body may begin protecting the painful area.

Think about what happens when you hurt your back.

You automatically tense the surrounding muscles.

You don’t consciously decide to do it.

Your body is trying to protect you.

The same thing can happen with chronic pelvic pain.

Endometriosis creates pain or irritation.

The pelvic floor tightens protectively.

Those tight muscles can then become painful themselves.

Penetration becomes uncomfortable.

Your brain anticipates that discomfort during the next intimate experience.

And the muscles tighten even earlier.

That creates a cycle:

Endometriosis pain → muscle guarding → pelvic floor tension → painful sex → increased anticipation → more guarding

This is why treating only one piece of the problem may not be enough.

Root-cause healing matters.

Myth-Busting: “If the Endometriosis Is Treated, Sex Shouldn’t Hurt”

It would be wonderful if pelvic pain always had one simple cause.

But women’s health rarely works that way.

Myth: Endometriosis lesions are the only cause of painful sex

Reality: Endometriosis may be one contributor, but pelvic floor tension, scar tissue, inflammation, nervous-system sensitivity, vaginal dryness, and other conditions can also contribute.

Myth: Pain with sex means something is permanently damaged

Reality: Pain doesn’t automatically mean permanent damage. Muscles and the nervous system can develop protective patterns that may improve with appropriate treatment.

Myth: You just need to relax

Reality: Telling someone with chronic pelvic floor tension to “relax” is not a treatment plan.

Mayo Clinic notes that deep pain during sex may be associated with conditions including endometriosis and pelvic floor disorders. Stress and fear of painful sex can also contribute to pelvic floor tightening and continued discomfort. Mayo Clinic

You deserve better than fear-based advice or being told that pain is simply something you have to tolerate.

The Root Cause Is Often More Than One Thing

For many women with endometriosis, painful intimacy is multifactorial.

That means several systems may be involved at the same time.

You may have:

  • Irritated endometriosis lesions
  • Pelvic adhesions
  • Pelvic floor muscle guarding
  • Trigger points or tender muscles
  • Changes in movement patterns
  • Nervous-system sensitivity
  • Fear created by previous painful experiences

This is important because pelvic floor physical therapy doesn’t remove endometriosis.

Instead, physical therapy may help address the muscular and movement-related consequences that can develop alongside endometriosis.

That distinction matters.

The goal isn’t to pretend the underlying disease doesn’t exist.

The goal is to identify every contributor to your pain that can be treated.

Practical Steps if Endometriosis Makes Sex Painful

1. Stop Pushing Through Significant Pain

Pain doesn’t need to become the price you pay for intimacy.

Repeatedly forcing penetration through substantial pain may increase fear and muscle guarding.

Slow down and listen to what your body is telling you.

2. Pay Attention to Where the Pain Happens

Is the discomfort:

  • At the vaginal entrance?
  • Deep inside the pelvis?
  • Worse in certain positions?
  • Worse during particular parts of your menstrual cycle?
  • Present afterward as well?

These patterns can provide useful information to your healthcare team.

3. Practice Diaphragmatic Breathing

Find a comfortable position and breathe slowly into your ribs and abdomen.

As you inhale, imagine your pelvic floor gently softening and widening.

Don’t force it downward.

The goal is simply to practice allowing the muscles to let go instead of constantly gripping.

4. Stop Constantly Bracing Your Core

Check in with your body throughout the day.

Are you always sucking in your stomach?

Holding your breath?

Clenching your glutes?

Chronic bracing can add unnecessary tension throughout your core and pelvic floor.

Practice allowing your abdomen to relax during normal breathing.

5. Work With the Right Healthcare Team

Endometriosis often requires multidisciplinary care.

A gynecologist or endometriosis specialist can address the underlying disease.

A pelvic floor physical therapist can assess whether muscle tension, movement patterns, scar tissue, breathing mechanics, or nervous-system guarding are also contributing to your symptoms.

Understanding your body creates confidence.

Reclaiming Comfortable Intimacy

Endometriosis is complex.

But pain with sex doesn’t have to remain a mystery.

Your discomfort may involve endometriosis itself, restricted tissues, pelvic floor guarding, nervous-system sensitivity, or several of these factors at once.

That doesn’t mean your body has failed.

Your body is not broken.

It means your symptoms deserve a complete explanation—not another generic recommendation to use more lubricant or simply relax.

The goal isn’t temporary relief—it’s long-term strength, comfort, and a treatment strategy that recognizes how interconnected your body really is.

You deserve providers who listen to you.

You deserve care that considers more than one possible cause.

And you deserve intimacy that isn’t defined by fear of pain.

If you’re ready to stop guessing and start understanding your body, schedule an appointment to create a personalized plan that addresses the root cause—not just the symptoms.

Not sure what your pelvic floor needs next? Complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals.

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