Understanding and Addressing Fear in Persistent Pelvic Pain 🌸

For many living with persistent pelvic pain, one emotion rises above the rest: FEAR.

Patients frequently report fears such as:

• “What if it’s something harmful we haven’t found yet?”
• “Will this pain ruin my relationships or intimacy?”
• “What if it continues to get worse?”
• “Will I ever be able to enjoy my life again?”

Research shows that Fear plays a central role in maintaining pain. The Fear-Avoidance Model explains how this unfolds:

Pain-Related Fear – when the person interprets pain as a sign of tissue (muscle, nerve, organ) ongoing damage or a new injury.

Pain-Related Avoidance – avoiding movements, intimacy, or activities that might trigger pain.

Cycle of Disability – avoidance leads to deconditioning, muscle tension, and greater sensitivity—fueling the pain.

Consequences of Avoidance – loss of confidence, reduced physical functioning, hypervigilance to bodily signals, and even depression.

But there is hope. Studies show that when patients learn pain neuroscience education (PNE) and are guided through graded exposure, self-soothing, and calming strategies, their Fear decreases, and their ability to function and live meaningfully improves. 

🧠 The nervous and immune systems are not bystanders to our health. They are actively involved 24/7 and, with persistent pain, have learned to be upregulated or hypersensitive. By encouraging patients to engage in learning and practicing the self-management skills, they can relearn safety, downregulate, and eventually experience pelvic wellness.

💡 For practitioners:

Helping patients name their Fear and gently linking it to central sensitization can open the door to new strategies. Scripts and patient handouts can make these conversations easier.

📄 I’ve created a sample clinician script + handout that you can use in practice to address Fear in persistent pelvic pain. Message me if you’d like access. Handout Addressing Fear in Persistent Pelvic Pain

References:

Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. (2007). The fear-avoidance model of pain: A critical review. Behaviour Research and Therapy, 45(1), 77–94. https://pubmed.ncbi.nlm.nih.gov/17180640/

Vlaeyen, JWS & Linton, SJ. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317–332. https://pubmed.ncbi.nlm.nih.gov/10781906/