Why Trauma Survivors Experience Pelvic Floor Dysfunction—And How to Heal

This blog was written by guest author, Victoria (Tori) Mallow, PT, DPT, MA, a physical therapist specializing in the treatment of pelvic floor conditions. 

How Trauma Affects the Pelvic Floor

When we experience perceived or actual danger, our body's natural response is to react with fight, flight, fawn, or freeze. Some of the physiological changes we may notice include increased heart rate, faster breathing rate, body temperature increase, and muscle tension. It can be easier to acknowledge tension in the shoulders or grinding teeth, but what may not be as obvious is the involuntary tension that builds in the pelvic floor muscles. A study back in 1999 by J Van der Velde and W. Everaerd looked at the response of the pelvic floor muscles, via vaginal electromyography, as women were exposed to threatening images. Their research concluded, “It is the threatening content of the situation that evokes this involuntary activity of the pelvic floor."

Increased pelvic floor tension, repetitively or over a long period of time, will create a scenario where the muscles no longer relax well and stay perpetually in a guarded or “hypertonic” state. This tension restricts blood flow and oxygen to the tissue and can impact the function of neighboring structures such as nerves, connective tissue, and ligaments. This often results in pain, bladder/bowel dysfunction, and sexual discomfort.

What Pelvic Floor Therapy Can Do for Trauma Survivors

Pelvic Floor Dysfunction often develops following trauma and specifically people may experience one or more of the following symptoms:

• Pelvic pain
• Pain with sexual activity (Dyspareunia, Anodyspareunia)
• Vaginismus
• Chronic prostatitis
• Constipation
• UTI-like symptoms, without infection
• Bladder or Fecal Leakage

Pelvic Floor Therapy addresses these symptoms by improving the function of the musculoskeletal and neuromuscular systems. Our therapeutic goal is to empower patients to reconnect with their bodies, in order to reduce pelvic tension and restore function of the pelvic tissues. There are a number of ways we achieve this which include but are not limited to:

• Hands-on/manual therapy
• Mobility and movement-based exercises
• Breathwork and nervous system regulation

It’s important to know that not every Physical Therapist does this work, and therefore, seeking out someone with specialized training who can provide a safe space for body awareness and healing is key. Your therapist should be able to modify treatment in a way that allows you to feel comfortable and in control. At Restore Pelvic Health & Rehab, chronic pelvic pain makes up about 50% of our practice, and many of our patients come to us with a history of trauma. In fact, helping those with a history of trauma is one of my greatest passions and the reason I opened my practice.

Why Mental Health and Pelvic Floor Therapy Go Hand in Hand

“So many people live with unexplained pelvic floor issues without realizing the connection to their past experiences. Trauma work can be life-changing – not just for the mind, but for the body’s deepest, most vulnerable spaces.” - Brian Gong, LMHC, CAP, Founder of Mangrove Therapy Group in Delray Beach, Florida.

A dual approach to healing, with a trauma-trained mental health therapist and a trauma-trained pelvic floor therapist can be an absolute game changer for trauma survivors. When collaboration among these providers exists, it can ensure consistent progress safely and comfortably.

To better understand the importance of this collaboration, consider this case scenario:

Maria, a 32-year-old trauma survivor, sought pelvic floor therapy after years of painful intercourse and chronic pelvic tension. She was hopeful that addressing the physical symptoms would bring relief. However, during her first few treatment sessions, she found herself feeling unexpectedly anxious, tense, and overwhelmed. Though her therapist used a trauma-informed approach, Maria’s body instinctively reacted with fear, making it difficult to tolerate even gentle techniques. Thankfully, Maria confided in her pelvic floor therapist that she was feeling uneasy and was concerned therapy “wasn’t working” for her. 

Maria’s pelvic floor therapist helped her to find a mental health provider who could help her work through her past experiences, in conjunction with PT, and this is when things started to shift. Through therapy, Maria began to process the deep-seated emotional responses that had been stored in her body for years. She learned techniques to regulate her nervous system, gradually allowing her to feel safer in her own body. Working with her pelvic floor therapist and mental health therapist collaboratively, she was able to make real progress—reducing pain, restoring function, and ultimately being able to enjoy intimacy in the way she wanted.

This scenario highlights why healing from trauma often requires a team approach. Trauma isn’t just stored in the mind—it’s held in the body. When pelvic floor therapists and mental health professionals work together, patients can heal both physically and emotionally, leading to long-term relief and a better quality of life.

What You Can Do

If you’ve been living with the effects of trauma—whether it’s pain, discomfort, or feeling disconnected from your body—know that change is within reach. Your experiences do not define your future, and your body has the capacity to heal. There are people dedicated to walking with you along this journey. If you are local to South Florida, we would love to be considered as a future team member in your trauma and pelvic health healing.

Dr. Victoria (Tori) Mallow is a dedicated Pelvic Floor Physical Therapist and the Founder of Restore Pelvic Health & Rehab in East Delray Beach, Florida. She earned her Doctorate in Physical Therapy from Washington University, in St. Louis and holds a Master’s in Science Education from Columbia University. She graduated Summa Cum Laude from SUNY Albany with a B.S. in Human Biology. Recognizing the need for a specialized, patient-centered approach to pelvic health, Dr. Tori established her practice to provide the highest quality of individualized care in a safe, private, and supportive environment. She treats all genders experiencing pelvic floor dysfunction, using evidence-based treatment strategies to help patients regain confidence and improve their quality of life. Dr. Tori is a Certified Clinical Instructor through the APTA, a Certified Pregnancy & Postpartum Corrective Exercise Specialist, and a Certified Sex Counselor, further expanding her expertise in pelvic health, rehabilitation, and patient education.

Start Trauma Treatment in Palm Beach County, FL

Mangrove Therapy Group specializes in the treatment of trauma and addressing the root causes of symptoms such as pelvic floor dysfunction. We are experts in the use of EMDR Therapy as a tool to address all forms of emotional and psychological wounding. Contact our Delray Beach office today to start the healing process!

Other Services Offered with Mangrove Therapy Group

Trauma treatment isn't the only service Mangrove Therapy Group offers. We are happy to offer support with a variety of mental health services including anxiety, EMDR, PTSD/C-PTSD, substance use disorders, eating disorders, body image issues, anger management, anxiety, low self-esteem, personality disorders, and much more. We also offer support with addictions such as process addictions, grief and loss, “Failure to Launch” syndrome, CBT, and DBT. Please feel free to learn more about how we can support you. You can start learning more by visiting our blog or FAQ page to learn more today!