Setting Aside Assumptions: A Case Study on Treating Pelvic Pain

In this pelvic health case study, a body-guided, assumption-free approach reveals how listening to the tissues can create safety, connection, and lasting change in pelvic pain care.

Client Presentation

The client presented with a lifelong history of painful menstruation, beginning with her very first cycle in 8th grade. Her pain consistently started 1–2 days prior to the onset of menses and persisted for 2–3 days after bleeding began. In addition, she reported lifelong dyspareunia: she had never been able to insert a tampon or tolerate penetrative intercourse due to pain.

She had seen multiple healthcare providers over the years but had never received a clear explanation for her symptoms or pathway to resolve them.

Initial Clinical Reflections (and Setting Them Aside)

As pelvic health clinicians, we are keenly aware that conditions such as endometriosis can take years – sometimes decades – to be diagnosed. Given her symptom history, this was an early consideration, and a topic I discussed with her. She had never heard of endometriosis in her visits with multiple providers.

Similarly, when hearing a history of dyspareunia, it can be easy for our minds to jump to possible trauma or sexual abuse. While these were thoughts I noted internally, I intentionally set them aside. I approach sessions with neutrality, allowing the body and tissues to guide the work rather than letting my assumptions take the lead.

Physical Assessment

Standing assessment:

No significant findings emerged.

Supine assessment:

As I listened to her tissues and assessed her ability to connect into her pelvic space, I guided her through a visualization, asking her to imagine a color flowing through her body and down into her pelvis. She reported that she could not get the color past her umbilicus.

I then slowly walked my hand down the anterior trunk. When I reached the diaphragm, I felt a clear boundary – my hand was not “allowed” to go further. This indicated an energetic and protective block that needed to be addressed before working directly in the pelvic space.

From my clinical experience, tissues respond more effectively when there is full connection and safety within the body. While it would have been possible to proceed directly to pelvic work, releasing this block first was essential to allow true engagement with the tissues below.

Addressing the Diaphragmatic Block

I asked the client to tune into her diaphragm. She immediately noticed tension accompanied by fear and a sense of not feeling safe. My assumption, again, went to potential trauma or abuse, but as I tuned into her system, I did not perceive a trauma response in my own body (which, for me, often presents as visceral tightening or a strong somatic “ugh!” response in my own body). Instead, what arose intuitively was an image of her as a young child.

When I asked about her as a little girl, she described herself as very shy. I asked how her parents responded to this, and she shared that they did not. What became clear was a pattern of being pushed into the world before she felt ready. The world felt unsafe, and that sense of fear had been held in her diaphragm.

As we supported her younger self in recognizing that her adult, present-day self was now with her, the diaphragm softened. Both of us felt it: there was a noticeable release and a new sense of flow down into her abdomen.

Pelvic Findings and Treatment

With this improved connection, I moved my attention to her pelvis. The findings were unexpected.

Her sacrum was notably hard and restricted on the right side. I invited her to sense this difference herself, which she was able to do. When asked about any falls or injuries to her tailbone or buttocks, she could not recall any.

I honored the sacrum by simply holding it and then tuned into her uterus. The uterus felt enlarged, firm, and pulled to the right. Holding both the sacrum and uterus with the intention of connecting through the uterosacral ligaments, I felt a softening occur. A direct uterosacral ligament release led to another clear layer of change.

When reassessing the sacrum, the right side had softened, and the left side now required attention. As I continued working, the tissues gradually released. The uterus became more centered, softer, and returned to a more typical size and mobility.

We reached the end of the session at this point.

Immediate Outcomes

When the client stood up, she immediately noticed a lightness in her pelvic space – something she had never experienced before. She also demonstrated improved trunk mobility and expressed amazement at the change she felt in her body.

Plan of Care

The client is due to begin her next menstrual cycle in approximately two weeks. I plan to reassess her following that cycle to evaluate changes in her pain experience. Dyspareunia will be addressed in subsequent sessions as her body continues to integrate this work.

Clinical Takeaways

This case highlights the importance of addressing blocks that disconnect a person from their pelvic space before initiating internal pelvic floor work. Establishing safety, connection, and tissue readiness is foundational to effective and respectful care.

It also underscores the value of setting aside assumptions. While endometriosis or trauma may still be part of this client’s story, they did not present themselves in this session. Our responsibility as clinicians is to treat what shows up – listening to the body rather than leading with preconceived narratives. When we let our assumptions lead the way, we may miss what the body truly needs in the moment to promote optimal healing.

Setting aside assumptions and coming into each session with neutrality and presence allows the tissues to guide the process. When we truly listen, the body tells us exactly where to begin.

To learn more about working with the pelvic space and setting aside assumptions to listen to the body’s guidance, check out the Internal Pelvic Floor Treatment course. This online 5-hour continuing education course will provide you with the tools to help connect your client with their pelvic space to provide safe and respectful intravaginal treatment.

About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com