Sexual pain · 7 min read

Sexual Pain Disorders Therapy: You’re Not Broken, and You’re Not Alone

Pain during sex is real, recognized, and treatable. We work alongside your medical providers on the therapy piece — the fear, the bracing, and the weight pain carries.

Written and clinically reviewed by Vanessa Cushing, LPC, NCC, MS — AASECT-Certified Sex Therapist, licensed in Virginia & Florida. The Cushing Counseling team covers Virginia, DC, Maryland & Florida.

What falls under “sexual pain disorders”?

Several overlapping conditions can cause pain with sex or touch. They can occur on their own or together, and they can have physical roots, nervous-system roots, or — most often — both.

For a closer look at how these three terms differ, see our companion guide, Dyspareunia vs. Vaginismus vs. Vulvodynia.

• Dyspareunia — pain during intercourse; a descriptive term for a symptom rather than a cause.
• Vaginismus — involuntary tightening of the pelvic floor muscles that makes penetration difficult or impossible.
• Vulvodynia — chronic pain in the vulvar area that may occur with or without touch.

Why sexual pain isn’t “just in your head” — or “just physical”

One of the most damaging myths about sexual pain is that it must be either a medical problem or a psychological one. In reality, pain is processed by the nervous system, and the nervous system doesn’t neatly separate “body” from “mind.”

A pelvic floor that has learned to brace in anticipation of pain, a nervous system shaped by earlier medical or sexual trauma, and tissue-level irritation can all feed into and reinforce one another. Effective care usually means addressing the whole system, not just one piece of it.

The nervous system, protection, and trauma

For many clients, sexual pain develops or worsens after a distressing medical experience, a history of sexual trauma, or years of anxious anticipation before sex.

From an Internal Family Systems (IFS) lens — the core clinical approach we use at Cushing Counseling — the body’s guarding response can be understood as a protective part doing its job: bracing, tensing, or shutting down to prevent anticipated pain or harm. That response made sense at some point. Therapy isn’t about forcing the body to override it; it’s about helping that protective part learn, at a pace the body can tolerate, that safety is possible now.

Our approach at Cushing Counseling

We are not a medical practice and cannot diagnose or treat the physical causes of pelvic or vulvar pain. What we offer is the therapy piece of a well-rounded care team.

• Trauma-informed, IFS-based individual therapy to address fear, bracing, and the emotional weight pain can carry.
• Couples-inclusive sessions when pain is affecting a relationship, so partners can move through it as a team rather than as a source of shame or distance.
• Coordination with your OB-GYN, urologist, or pelvic floor physical therapist so your care stays aligned rather than fragmented.
• Sensate focus and other structured, non-goal-oriented exercises, introduced only when appropriate and at your pace.

When to see a doctor first

If pain is new, sudden, or worsening, or if you notice bleeding, discharge, or fever alongside it, please see a gynecologist, urologist, or your primary care provider before or alongside starting therapy.

Sexual pain is frequently best treated by a team — physician, pelvic floor physical therapist, and therapist working together — and ruling out or treating an active medical cause is an important first step.

Frequently asked questions

Keep reading

• Dyspareunia vs. Vaginismus vs. Vulvodynia — A plain-language breakdown of three commonly confused conditions.
• Painful Sex & Vaginismus Therapy — The existing page on painful sex — read alongside this pillar.
• Women’s Sexual Health — The broader hub: desire, arousal, pain and hormonal transitions.
• IFS Therapy: What to Expect — Our core trauma approach — Internal Family Systems, not EMDR.
• Sexual Trauma Therapy — When pain and past trauma are tangled together.
• Sensate Focus — The structured, non-goal-oriented touch practice we often use.

Also on this site

• Fees & Insurance — Rates, out-of-network reimbursement and what to expect.
• Book a free consultation — A short call to work out whether this is the right fit.
• Contact us — Questions about coverage, scheduling or fit.

Clinical resources this page draws on

• American College of Obstetricians and Gynecologists (ACOG) — Clinical guidance on evaluating and treating sexual pain.
• International Society for the Study of Women’s Sexual Health (ISSWSH) — Professional body publishing guidance on sexual pain conditions.
• IFS Institute — The training and certification body for Internal Family Systems.