Pain can reshape the whole sexual relationship
When sex hurts, the nervous system learns to anticipate danger. A person may tense before touch begins, lose desire, disconnect from the body, or avoid intimacy altogether. Partners may become afraid to initiate, uncertain how to help, or hurt by the distance that follows.
Diana works gently and directly with the emotional, relational, and sexual consequences of pain. Therapy proceeds at your pace. There is no pressure to engage in painful activity and no assumption that the problem is merely psychological.
Common reasons people seek help
- Pain with penetration or other sexual touch
- Vaginismus, vulvodynia, pelvic pain, or pain after medical changes
- Fear and muscle guarding before intimacy
- Loss of desire after repeated painful experiences
- Relationship strain, guilt, or misunderstanding
- Rebuilding intimacy after treatment, surgery, childbirth, or menopause
Care that respects both body and relationship
Painful sex often benefits from collaborative care. Depending on your needs, that may include a physician, pelvic-floor physical therapist, or another qualified medical professional. Sex therapy addresses the fear, communication, identity, grief, and relationship patterns that medical treatment alone may not resolve.
The work can include expanding the definition of intimacy, restoring a sense of choice, reducing performance pressure, and helping partners become a supportive team.
Experienced, specialized care
Diana Urman, PhD, LCSW, has more than 20 years of clinical experience and advanced training in human sexuality. Her style is warm, direct, and practical. She works with individuals and couples from her Noe Valley office and by telehealth across California.
Related services
Frequently asked questions
Does painful sex mean the problem is psychological?
No. Sexual pain can have many physical causes. Therapy addresses its emotional and relational effects and can complement appropriate medical treatment.
Will therapy require sexual activity that hurts?
No. Therapy should not pressure you to repeat painful experiences. The work emphasizes consent, safety, and gradual, individualized steps.
Can partners attend together?
Yes. Couples work can improve communication, reduce pressure, and help both partners rebuild closeness in ways that respect the person experiencing pain.