Vaginismus is often described as “pain with penetration,” but that definition misses the bigger picture. In this episode, couples and sex therapist Dr. Rebecca Howard Eudy and pelvic floor physical therapist Dr. Alexandra DiGrado unpack what vaginismus really is, why it happens, and how it affects far more than just sex.

Together, they explore the role of the nervous system, pelvic floor muscles, fear-avoidance patterns, and past experiences—and why advice like “just relax” can actually make things worse. This conversation offers clarity, compassion, and an evidence-based path forward for anyone navigating pelvic pain or supporting someone who is.

What You’ll Learn:

• Why vaginismus is a protective nervous system response—not a psychological failure or conscious choice
• How the fear–tension–pain cycle develops and reinforces ongoing pain
• Why vaginismus can affect more than penetration, including exams, tampon use, sitting, and bowel function
• What effective treatment actually looks like, including pelvic floor PT, education, and nervous system regulation
• How healing focuses on safety, choice, and gradual progress—not pushing through pain

Tune in if you’ve ever thought:

• “Everyone keeps telling me to relax, but I literally don’t know how.”
• “Can this ever get better, or will it always hurt like this?”
• “How do I explain this to my partner, and what does it mean for our relationship long-term?”
• “I feel embarrassed talking about this — am I the only one?”
• “How do I get help without forcing myself through more pain?”

Helpful Resources

• Intimate Rose anal/vaginal dilators (use code ALEXANDRA1 for 20% off - affiliate link)
• The Postpartum Essentials Virtual course
• Sex After Baby Mini-Course
• Find a pelvic floor PT near you: pelvicrehab.com or Pelvic Global Directory
• Under the Hood Newsletter (Boston Pelvic PT)
• Parents in Love Newsletter by Dr. Rebecca Howard Eudy
• Parents in Love: A Guide to Great Sex After Kids by Dr. Rebecca Howard Eudy

Connect with us:

Dr. Rebecca Howard Eudy

• Website: https://www.rebeccaeudy.com
• Instagram: https://www.instagram.com/rebeccahowardeudy/
• Newsletter: https://substack.com/@parentsinlove

Dr. Alexandra DiGrado

• Website: https://www.bostonpelvicpt.com
• Instagram: https://www.instagram.com/bostonpelvicpt/
• Newsletter: https://bostonpelvicpt.myflodesk.com/underthehood

Podcast

• Instagram: https://www.instagram.com/underthehooddocs/
• Website: http://www.underthehoodpod.com

In this episode, Dr. Rebecca Howard Eudy (couples and sex therapist) and Dr. Alex DiGrado, DPT, PRPC (pelvic floor physical therapist) discuss how your nervous system, muscular habits, and past experiences (including trauma and chronic stress) are all connected to chronic pelvic pain. Whether you’ve been dismissed by the healthcare system, or are looking to better understand the connection between your body and brain, this conversation will leave you feeling informed, seen, and empowered to seek relief for yourself and your loved ones.

What You’ll Learn:

• The 10-Year Delay: Why conditions like endometriosis take so long to diagnose and how these conditions contribute to chronic muscular pain.
• The Ab Gripping Habit: How chronic ab-tightening (often thanks to diet culture and fitness trends) can lead to a chronically tight, painful pelvic floor.
• The Fire Alarm Analogy: Why your body continues to send very real, strong pain signals even after an infection (like a UTI) or injury has been treated.
• Lifestyle Optimization: The often-overlooked connection between pelvic tension, low back pain, bowel movements, and overall wellness.

Tune in if you’ve ever thought:

• “I feel like I'm going crazy—I know my pain is real, but my doctor keeps telling me everything ‘looks normal’.”
• “Why does it seem like I constantly have a UTI even though my tests are negative?”
• “How can pelvic floor PT help my chronic pain when it’s caused by a disease like endometriosis (or PCOS, IBS, and more), rather than a specific injury?"

Resources

• Explain Pain by Lorimer Moseley
• The Body Keeps the Score by Bessel van der Kolk
• Nancy's Nook (Endometriosis education + resources)
• Beating Endo by Dr. Iris Kerin Orbuch and Amy Stein
• Find a pelvic floor PT near you: pelvicrehab.com or Pelvic Global Directory
• Under the Hood Newsletter (Boston Pelvic PT)
• Parents in Love Newsletter by Dr. Rebecca Howard Eudy
• Parents in Love: A Guide to Great Sex After Kids by Dr. Rebecca Howard Eudy

Connect with us:

Dr. Rebecca Howard Eudy

• Website: https://www.rebeccaeudy.com
• Instagram: https://www.instagram.com/rebeccahowardeudy/
• Newsletter: https://substack.com/@parentsinlove

Dr. Alexandra DiGrado

• Website: https://www.bostonpelvicpt.com
• Instagram: https://www.instagram.com/bostonpelvicpt/
• Newsletter: https://bostonpelvicpt.myflodesk.com/underthehood

Under the Hood Podcast

• Instagram: https://www.instagram.com/underthehooddocs/
• Website: http://www.underthehoodpod.com

Most people hear “pelvic floor PT” and think, “So…Kegels and an awkward exam?” But here’s what most people don’t realize: good pelvic floor physical therapy is full-body, trauma-informed care that connects your bladder, bowel, sexual function, posture, breathing, and stress levels—not just your vagina, penis, or “down there.”

In this episode, Dr. Rebecca Howard Eudy (couples and sex therapist) and Dr. Alex DiGrado (pelvic floor physical therapist) pull back the curtain on what actually happens in a pelvic floor PT visit. From the intake questions to the internal exam (always optional, always consent-based), they walk through how a skilled PT looks at your whole body, your nervous system, and your real life to understand what’s going on.

Whether you’re leaking when you sneeze, dealing with constipation, dreading sex because it hurts, or just wondering if your “weird” symptoms are normal, this conversation will leave you informed, de-shamed, and more confident about getting the help you deserve.

What You’ll Learn

• What really happens at a pelvic floor PT appointment
• Why training and approach matter so much in the PFPT you choose
• The truth about Kegels (and why tight muscles are weak muscles)
• How your whole life shows up in your pelvis
• Signs that pelvic floor PT could help you

Tune in if you’ve ever thought:

• “Isn’t pelvic floor PT just Kegels?”
• “I had a weird pelvic floor PT experience—do I really want to try again?”
• “Why am I leaking, in pain, or running to the bathroom all the time?”
• “Is it normal that sex hurts (or feels numb) after childbirth or surgery?”
• “What actually happens in an internal exam—and do I have to do one?”

Resources

• Pelvic floor + postpartum support & courses
  • The Healthy Pelvis Project – virtual pelvic health and postpartum support:
    https://thehealthypelvisproject.podia.com/
• Find a pelvic floor physical therapist near you
  • Pelvic Rehab Provider Directory:
    http://pelvicrehab.com/
  • Pelvic Global PT Directory:
    https://directory.pelvicglobal.com/
• Sex & Relationships
  • Parents in Love: A Guide to Great Sex After Kids by Dr. Rebecca Howard Eudy

Connect with Us

• Dr. Rebecca Howard Eudy
  • Website: https://www.rebeccaeudy.com
  • Instagram: https://www.instagram.com/rebeccahowardeudy/
  • Newsletter: https://substack.com/@parentsinlove
• Dr. Alexandria DiGrado
  • Website: https://www.bostonpelvicpt.com
  • Instagram: https://www.instagram.com/bostonpelvicpt/
  • Newsletter: https://bostonpelvicpt.myflodesk.com/underthehood
• Podcast
  • Instagram: https://www.instagram.com/underthehooddocs/
  • Website: http://www.underthehoodpod.com