-DR. HEATHER S. HOWARD, Sexologist  Mind-Body Health Facilitator


If you experience physical pain, you might consider yourself lucky to be able to do just one thing on a regular basis that brings both you and your partner pleasure.  Sometimes nothing feels good—or maybe nothing ever feels good.  You might choose to endure the least painful sexual option to satisfy your partner, or you might choose to avoid any touch because it could lead to painful sexual activity. Many people who have undergone successful pain treatment will avoid reintroducing sexual activity because they associate sex with pain.

If you are feeling like your options are limited, working with a clinical sexologist who understands chronic pain can help you to expand your options and find satisfying sexual activities for both you and your partner.

Common challenges for people with chronic pain are fear of pain, lost confidence, lost sexual identity, mind-body dissociation, damaged body image, and difficulty communicating with partners about sexual needs. Clinical sexology using mind-body integrative techniques can address those challenges.

There are many pain conditions or conditions that cause limited mobility. I (Dr. Heather Howard) have worked with clients who have experienced a broad range of pain and health conditions. Because of my experience with managing my own pelvic pain condition and my research in pelvic pain, I am uniquely qualified to work with clients who have been diagnosed with the following pelvic and sexual pain conditions:

  • Chronic Pelvic Pain Syndrome: constant or recurring pain in the pelvic region (defined as anywhere from the abdomen all the way down to the inner thighs). With chronic pelvic pain, sex is often a source of pain and relationship stress.
  • Dyspareunia: painful vaginal penetration. With dyspareunia, sex is often a source of pain and relationship stress.
  • Endometriosis: growth of the uterine lining outside of the uterus which can result in pelvic pain. With endometriosis, sex is often a source of pain and relationship stress.
  • Female Sexual Dysfunction: sexual difficulties including decreased desire, decreased arousal, difficutly or inability to reach orgasm, and sexual pain that are caused by biological, psychological and/ or sociological factors. Sexual difficulties and pain are often a source of relationship stress.
  • Hypertonic Pelvic Floor Dysfunction / High-tone Pelvic Floor Dysfunction: tense pelvic floor muscles which can cause or perpetuate pelvic pain. With hypertonic pelvic floor dysfunction, sex is often a source of pain and relationship stress.
  • Interstitial Cystitis / Painful Bladder Syndrome: burning, discomfort or severe pain felt in the bladder and/ or the pelvic region. With intersitial cystitis, sex is often a source of pain and relationship stress.
  • Pelvic Floor Dysfunction: underactive or overactive pelvic floor muscles that can be associated with incontinence, pelvic organ prolapse, or pain. With pelvic floor dysfunction, sex is often a source of pain and relationship stress.
  • Peyronie's Disease: penile scar tissue that can cause a bend in the penis, painful erections and/ or erectile difficulty.
  • Pudendal Neuralgia: nerve pain felt in the pelvic region. With pudendal neuralgia, sex is often a source of pain and relationship stress.
  • Vaginismus: pelvic pain or tension that can prevent vaginal penetration. With vaginismus, sex is often a source of pain and relationship stress.
  • Vulvar Vestibulitis / Vestibulodynia: pain in the vaginal opening. With vulvar vestibulitis, sex is often a source of pain and relationship stress.
  • Vulvodynia: vulvar pain. With vulvodynia, sex is often a source of pain and relationship stress.
Pain with sex is common in all of these conditions; sexual pain symptoms in women include abdominal pain, clitoral pain, vulvar pain, vestibular pain, vaginal pain, perineal pain, anal pain, bladder pain, arousal pain, orgasm pain, and tension that causes pain and can prevent vaginal penetration. I can help you to achieve a satisfying and connected sexual relationship despite these symptoms and can also help you to manage your pain symptoms through sexual activity and coordination with your health care team.

For general information on Chronic Pelvic Pain, please download this Patient Education Booklet from the International Pelvic Pain Society or follow the links on the Additional Resources page of this website.

For more information on how clinical sexology works and the services available to you, please visit the About Clinical Sexology page, the Consultation page, and the Common Questions page.

In addition to clinical options, The Center for Sexual Health and Rehabilitation offers products and devices that enhance pleasure and reduce pain for those with chronic pain and limited mobility.  I have developed a medical-grade lubricant for this purpose (which is in production), as well as a medical-grade glass tool that allows clients to do pelvic floor release on themselves.  In addition to offering devices, I offer consultation to recommend the appropriate products for clients, given their specific needs. Clients who seek product consultation are under no obligation and receive no pressure to purchase products from The Center for Sexual Health and Rehabilitation.    




"After more than ten years of physically and emotionally struggling with vulvodynia, my husband and I decided to try sex counseling. We only worked with Dr. Howard a few short weeks, but our time with her was completely transformative. Dr. Howard equipped us with strategies to manage pain flare-ups, tools for better communication (we didn't even know we needed), and techniques for enjoying our time together. Honestly, sex is easier and more satisfying than we ever thought possible! Dr. Howard is warm, professional, and easy to talk to. My husband and I both strongly recommend her for anyone struggling with pelvic pain."

-Couple after graduating from clinical treatment, San Francisco

      © 2009-2017 H. Howard. All rights reserved | 415.683.3231 | info@sexualrehab.com