Understanding Vaginal Pain: Why My Approach to Sex Therapy Works When Others Don’t
Vaginal pain is one of the most common yet least talked-about concerns women bring into therapy. Whether it shows up as painful intercourse (dyspareunia), vaginismus, pelvic floor tension, or unexplained burning and discomfort, it affects far more than just sex — it impacts self-esteem, intimacy, relationships, and overall quality of life.
For many women, the journey to relief is frustrating. You may have been told “it’s in your head,” prescribed lubricants or medications that didn’t help, or even left to believe pain is just something you have to live with. I’m Dr. Carli Blau, a licensed sex therapist with over a decade of experience changing the lives of women with vaginal pain.
I take a very different approach — one that validates your experience, explores both body and mind, and provides strategies for real, lasting relief. I don’t fixate with you on the vaginal pain you have, I historically investigate your life to understand where it began and how it manifested into a deeper and more painful problem for you in your life.
Why Vaginal Pain Happens
Most information online notes that vaginal pain can come from many sources:
Medical causes like endometriosis, infections, hormonal changes, or scar tissue.
Pelvic floor dysfunction where the muscles tighten involuntarily, making penetration painful.
Psychological factors such as anxiety, shame, or past trauma that create a mind-body cycle of pain.
Relational dynamics where fear, avoidance, or miscommunication between partners intensify the experience.
This is why a one-size-fits-all solution doesn’t work. The big problem is that medical doctors are taught to treat pain and dysfunction, but they’re not taught anything to do with sexual arousal, desire, or feeling. Vaginal pain is complex, and treating it effectively requires addressing both the physical and emotional layers.
How Most Sex Therapists Approach Vaginal Pain
Traditional sex therapy often focuses on either the relationship or the psychological side of pain. While these conversations are important, women are left without tools to connect what’s happening in their body to what’s happening in their mind. Some therapists avoid talking about medical or hormonal contributors altogether, which means women continue cycling through frustration, shame, and fear.
Why My Approach Works Differently
Not only have I been supporting women and their vaginal pain for over a decade, but I’ve dealt with it myself. With endometriosis and adenomyosis, I personally understand the impact of vaginal pain because I’ve been through it, and by following my protocol I learned to have enjoyable sex without pain.
At my office, I take an integrative approach that bridges the gap between the emotional, relational, and physical aspects of vaginal pain. Here’s how it’s different:
Comprehensive Assessment – I don’t assume pain is “just in your head.” I work collaboratively with gynecologists, pelvic floor physical therapists, and hormone specialists when needed to ensure all medical contributors are considered.
Mind-Body Connection – We explore how anxiety, fear, or past experiences affect the way your body responds to intimacy. By combining sex therapy techniques with relaxation training, mindfulness, and guided exercises, we retrain the body to respond with comfort instead of pain.
Women’s Hormone Health Expertise – Many sex therapists do not have training in hormonal influences. As a certified Women’s Hormone Health Coach, I integrate conversations about estrogen, testosterone, and other hormone shifts that directly impact vaginal comfort, lubrication, and arousal.
Partner Inclusion – When appropriate, partners are invited into therapy to learn how to support healing rather than unintentionally reinforce pain. Together, we rebuild intimacy and trust.
Personalized Sensate & Pelvic Strategies – Using tailored exercises, including sensate focus, graded exposure, and gentle communication tools, we create a path toward intimacy that feels safe and empowering.
The Results You Can Expect
Many clients report that after working with me, they not only reduce or eliminate vaginal pain but also:
Feel more confident in their bodies
Enjoy intimacy without fear
Improve communication with their partners
Rekindle desire and closeness in their relationship
Learn tools they can use long-term, even if pain flares again
Final Thoughts
You don’t have to live with vaginal pain — and you certainly don’t have to settle for therapy that doesn’t fully address the complexity of your experience. By combining clinical sex therapy, women’s hormone health expertise, and a collaborative medical lens, my approach offers a unique, holistic path toward healing that many women never knew existed.
If you’re struggling with painful sex, pelvic discomfort, or intimacy challenges, I invite you to take the first step. At the Dr. Carli Blau Center for Sex Therapy, you’ll find a safe, compassionate space to heal, reconnect, and reclaim your pleasure.
