When Pain, Anxiety, or Trauma Impact Intimacy
Abby Van Eman
Sexual Health Therapist
Sexual intimacy is often portrayed as something that should come naturally. We’re taught to expect it to be spontaneous, passionate, effortless. But for many people, intimacy feels complicated, confusing, or even distressing, especially when pain, anxiety, or trauma enter the picture.
If you’ve ever found yourself shutting down during sex, avoiding physical closeness, feeling disconnected from your body, or navigating discomfort that’s hard to explain, you’re not alone. These experiences are far more common than most people realize, and they don’t mean something is wrong with you. They mean something happened, or something is happening, that deserves your attention and care.
The truth is, intimacy doesn’t exist in a vacuum. Our bodies carry stories. Our nervous systems respond to memories, messages, and environments we may not even be consciously aware of. And when intimacy becomes a place where those responses are triggered, it can feel disorienting, isolating, or even shameful.
Sex therapy offers a space to name what’s happening, understand where it comes from, and gently begin the work of healing.
Pain is a Signal, Not a Failure
If sex has become physically painful, you’re not alone. Pain with sex can come from a range of causes, including vaginismus, endometriosis, pelvic floor dysfunction, hormonal changes, scar tissue, or medical trauma. It can also be a protective response to anxiety, past harm, or unresolved fear.
Pain is never just in your head. It’s your body trying to communicate something important. And when pain is dismissed, minimized, or misunderstood, it often creates layers of emotional hurt on top of the physical discomfort.
Therapy can help you process what the pain has meant for you emotionally, support communication with partners, and explore how to reconnect with your body on your own terms.
Anxiety Disrupts Connection
Even when you want to feel close, anxiety can interrupt your ability to enjoy intimacy. You might find yourself distracted, disconnected, or unable to relax. You might worry about performance, how you look, whether you’re doing it “right,” or whether your partner is satisfied. Sometimes, these thoughts become so overwhelming that you start avoiding intimacy altogether.
This isn’t about weakness or dysfunction. It’s often the result of social pressure, past experiences, or ongoing stress. Anxiety tends to live in the future, while intimacy asks us to be in the present. Therapy can help build the tools to come back to your body with kindness, awareness, and choice.
Trauma Changes the Body’s Response
For survivors of sexual trauma, coercion, or boundary violations, the body may no longer associate intimacy with safety. Even when your mind knows you’re safe, your body might respond with tension, numbness, dissociation, or shutdown. This can be deeply confusing and frustrating, especially in relationships where you feel emotionally close to your partner.
Trauma-informed sex therapy provides a space to gently explore what safety looks like now. This might include building awareness of triggers, exploring consent and choice, reconnecting with your body, and shifting patterns that were formed in survival. You set the pace. Nothing is rushed. Your story is honored.
This Doesn’t Have to Be the End of Intimacy
You are not broken. You are not too much or too complicated to love. When intimacy has become painful, triggering, or anxiety-filled, it’s easy to feel alone or ashamed. But your experience is valid. And you don’t have to carry it by yourself.
Sex therapy is not about pushing through or fixing you. It’s about slowing down, understanding what’s happening beneath the surface, and helping you reconnect with your body and relationships in ways that feel safe, supported, and right for you.
Healing is possible. Intimacy can become something new.
We Are Here For You
At Nashville Therapy Group, our team of clinicians is here to help you work through what’s hard and move toward meaningful change. Connect with us today to get started. We’d be honored to help you heal.
