Pelvic Pain: Breaking The Fear-Tension-Pain Cycle

Did you know that one of the most common reasons people seek pelvic floor physiotherapy is because they experience pain in their pelvic or vaginal area? Pain can be experienced with intercourse or other sexual contact, tampon use, medical exams, riding a bike, wearing tight clothes, etc. If you’re experiencing pelvic pain, know that while it is common, it is not something that you should be suffering through.

Pelvic pain can be a symptom of many different conditions including, but definitely not limited to:

  • Vaginismus
  • Vulvodynia / Vestibulodynia
  • Hypertonic (tense) pelvic floor muscles
  • Endometriosis
  • Vaginal infections
  • Muscle guarding in response to past pain
  • Hormonal changes

Dyspareunia (painful intercourse) can occur before, during or after intercourse and can be felt at the vaginal entrance, with deeper penetration, or even in the abdomen. 

People may experience painful intercourse because of vaginismus which is an involuntary tensing, or muscle spasm, of the muscles at the vaginal entrance making penetration or insertion into the vagina difficult, if not impossible. People who experience vaginismus most commonly report sensations of burning, stretching or stinging and feeling like penetration or insertion into the vagina is blocked by “hitting a wall” or that the vaginal entrance is too small.

For some people with pelvic pain this has always been present, and for others it is triggered and can occur even if you’ve previously been able to have pain free penetration.

The Fear-Tension-Pain Cycle

One of the contributing factors to pelvic pain is that our bodies end up in a Fear-Tension-Pain Cycle. So what exactly is this cycle?

Fear causes the body to hold tension which then increases the amount of pain we feel. The pain feeds the fear and the cycle continues. Many people are affected by this fear-tension-pain cycle. It can show up in many different situations or conditions, especially pelvic pain conditions. By uncovering our fears, working through them and re-training the brain to feel safe we can facilitate more positive experiences with the things that cause us pain.

What happens in the body and brain during this Fear-Tension-Pain Cycle?

You might associate pain with certain activities, like sexual intercourse, inserting a tampon, or having a medical exam. The anticipation of feeling this pain then tells your brain to send a signal to your pelvic floor muscles to tense up as a protection mechanism. Tension causes difficulty with insertion or penetration and therefore increases pain. This painful experience reinforces the belief that anything inserted into the vagina causes pain and thus you are in the cycle.

While pelvic pain is estimated to be experienced by 15-20% of women, it is not normal and there are treatment options available. Women’s health pelvic physiotherapists can help identify why you’re experiencing this pain. Treatments may include:

  • Muscle re-training
  • Breathing/relaxation strategies
  • Manual therapy (trigger point release/massage)
  • Dilator therapy
  • Stretches
  • Exercise 

Are you experiencing pelvic pain?

Our Pelvic Health Physiotherapist, Olivia Turgeon, is certified to treat pelvic health disorders such as urinary and fecal incontinence, pelvic organ prolapse, painful intercourse (dyspareunia), pelvic pain, abdominal separation (rectus diastasis) as well as birth preparation and pre-natal and post-partum rehabilitation. Olivia will work closely with you and the rest of the Lead team to ensure that you are receiving the care necessary to return to a high quality of life.