Chronic Pelvic Pain and the Nervous System: Why Psychotherapy Matters

Chronic Pelvic Pain and the Nervous System: Why Psychotherapy Matters

This blog was originally published on pelvichealthsupport.org a fantastic resource for multidisciplinary care for pelvic pain.

If you live with persistent pelvic pain or endometriosis, you likely already know how much effort it can take to hold your life together alongside it. Perhaps you’ve worked with multiple healthcare practitioners searching for answers prior to diagnosis, tried medications or hormonal treatments, or underwent physiotherapy and surgery. You may have felt relief at times, and at other times, deep frustration when the pain returned or never fully left.

I am a Registered Psychotherapist who works with individuals and couples experiencing persistent pelvic pain and endometriosis. In my work I see and hear the emotional weight of living with physical symptoms that have been unpredictable, disruptive, and, at times, isolating.

When navigating pelvic pain and endometriosis, receiving thorough medical care is essential. A diagnosis can bring language to your experience, and medical interventions can reduce inflammation, suppress lesion growth, and improve quality of life. At the same time, because endometriosis is a complex inflammatory disease, many people discover that even with excellent medical care, the pain does not fully resolve or may return after surgery. This is because persistent pain is not solely a tissue-based experience; it is largely shaped by the nervous system. 

Understanding Pelvic Pain Through the Nervous System

Underneath the daily work of managing symptoms, there is often exhaustion, frustration, and grief. For many, this might look like constantly weighing your limits, deciding whether to rest or push through, cancelling plans at the last minute, or showing up while quietly coping with pain. You may have also learned to override what your body is asking for in order to keep functioning through your many roles; friend, mother, sibling, colleague, daughter, partner. 

All the while you’re managing your roles and navigating pain flare-ups, your brain is scanning for threat and sending signals to keep you safe. These threats go beyond physical sensations and can include environmental dangers like a hot stove, emotional stress, relationship strain, work overwhelm, or major life changes such as loss or relocation. Feeling dismissed, unsupported, or alone in your pain can also be perceived as dangers. As the brain detects these threats, the nervous system becomes activated and ready to protect. But what happens when it remains in this activated state?

Psychotherapy helps us explore the parts of your experience that goes beyond a diagnosis or medical chart.

Neuroplastic Pain: How the Brain Shapes Symptoms

You may notice that your pain is not always consistent. It can flare during stressful or emotionally demanding times and ease during moments when you feel more supported, connected, or at ease. This reflects your nervous system asking a simple question: Am I safe? When safety feels uncertain, the body increases protection. In the pelvis, this often appears as muscle tension, guarding, and increased sensitivity. I love how Dr. Adele Stewart explains this concept in this video, describing how protective brain signals can contribute to pelvic pain.

Over time, after navigating repeated stress, the nervous system can become increasingly sensitive, and pain can become neuroplastic. It’s like a volume dial turned up too high. This doesn’t mean the pain is imagined; it means your body has become highly skilled at protecting you. But with so much practice at staying guarded, it can be difficult for the nervous system to shift back into a sense of safety, especially on your own. The hopeful part is that the brain is always capable of change. When we include the nervous system and emotional experience in a safe, therapeutic space, new pathways for healing can open.

The Role of Psychotherapy and Counselling in Multidisciplinary Care

Psychotherapy helps us explore the parts of your experience that goes beyond a diagnosis or medical chart. We look at patterns in your behaviour and beliefs that were shaped by earlier experiences and messages you received. You may have developed a perfectionist part to avoid criticism, or learned to push through discomfort, minimize your needs, or stay highly attuned to others’ expectations to keep the peace. These adaptations often form for good reasons, helping you function and maintain relationships, but they can also keep your nervous system in a state of tension.

We may gently explore when it feels safe to tune into your body, whether guilt arises when you need to rest, and the moments when expressing your needs has felt difficult. Together, we can process lived experiences, rebuild trust in your body, and help you feel not only safer, but more connected to yourself beyond the experience of pain.

A Note from Lived Experience

My own experience navigating endometriosis and adenomyosis has deeply shaped how I understand this work. It has reinforced my belief that healing happens when your nervous system learns – through experience – that it is safe to soften its guard.

With the right support, your body can learn new patterns. Patterns that allow for greater safety, flexibility, and relief. In that process, many people begin not only to experience less pain, but also to rediscover a deeper sense of trust in themselves and their bodies. 

If You’re Curious

If you’re tired of feeling stuck and alone with your pain, you're not alone—and you don’t need perfect words to begin. I welcome you to reach out.

Whether we focus on pain, anxiety, relationships, or simply creating space to breathe again, this work can help you reconnect to your body, your story, and your strength.

You don’t have to do it alone. Reach out today if you are ready for support.

Resources and Research

The following resources informed the perspectives shared in this article and reflect current research on chronic pain, nervous system sensitization, and pelvic pain, as well as the role of emotional and relational factors in pain experiences.

Lumley, M. A., Cohen, J. L., Borszcz, G. S., Cano, A., Radcliffe, A. M., Porter, L. S., Schubiner, H., & Keefe, F. J. (2011). Pain and emotion: A biopsychosocial review of recent research. Pain, 152(1), 1–10. https://doi.org/10.1016/j.pain.2010.09.027 

Orr, N. L., Wahl, K. J., Lisonek, M., Joannou, A., Noga, H., Albert, A. Y. K., Bedaiwy, M. A., Williams, C., Allaire, C., & Yong, P. J. (2022). Central sensitization inventory in endometriosis. Journal of Pain Research, 15, 2791–2800. https://doi.org/10.2147/JPR.S376065

Orr, N. L., Yong, P. J., Williams, C., & Allaire, C. (2025). Persistent pelvic pain, nervous system sensitization, and multidisciplinary care. Journal of Minimally Invasive Gynecology. Advance online publication. https://www.sciencedirect.com/science/article/pii/S2949838425000271

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.

Yong, P. J., Williams, C., Houlihan, E., & Allaire, C. (2017). Endometriosis and central sensitization: Clinical implications for pelvic pain management. Journal of Minimally Invasive Gynecology, 24(4), 552–559. https://doi.org/10.1016/j.jmig.2017.01.009

Yong, P. J., Orr, N. L., Williams, C., & Allaire, C. (2025). Advances in understanding central sensitization in endometriosis. Journal of Minimally Invasive Gynecology. Advance online publication. https://www.jmig.org/article/S1553-4650(25)00261-4/abstract

Stewart, A. (2021). Why pelvic pain hurts: The role of the brain and nervous system in pelvic pain [Video]. Vimeo. https://vimeo.com/517685081