Pelvic Pain Unpacked, Episode 12 — with Tamar Hill and Dr. Theresa Litz, PhD
🌿 Key Takeaways
- Sexual discomfort doesn’t just affect the body — the nervous system learns to associate intimacy with distress, and that rewiring requires intentional, therapeutic work to undo.
- Sex therapy is not what most people think it is. It’s talk therapy focused on the whole person — and it works best alongside pelvic floor physical therapy, not instead of it.
- Sensate focus, EMDR, and mindfulness are three clinically grounded techniques that help patients rebuild trust with their bodies and move toward sexual pleasure again.
- CBD works as a complementary tool by helping the body relax out of its braced, guarded state — without numbing sensation the way pharmaceutical options can.
- Healing is non-linear. Progress looks like more time between flare-ups and a growing capacity for pleasure — not a single breakthrough moment.
If pelvic discomfort has affected your ability to enjoy physical intimacy — or if you’ve simply stopped trying because it feels easier than dealing with the frustration — you are far from alone, and this conversation is specifically for you.
In Episode 12 of Pelvic Pain Unpacked, host Tamar Hill of MedRoots — a company specializing in CBD products for pelvic discomfort relief, sexual pleasure, menopause support, muscle discomfort, and overall wellness — sat down with Dr. Theresa Litz, PhD, a licensed clinical social worker, sex therapist, and EMDR-trained practitioner who specializes in the intersection of pelvic discomfort and sexual health. Tamar met Dr. Litz at a continuing education conference for pelvic floor physical therapists, where Dr. Litz was presenting on how sex therapy complements physical rehabilitation.
What unfolded was one of the most honest, hopeful, and clinically grounded conversations about sexual pleasure — and what gets in its way — that the show has produced.
Why Pelvic Discomfort and Sexual Pleasure Are Inseparable Topics
Tamar opened the conversation by acknowledging something that often goes unsaid: MedRoots hears regularly from people who have lost touch with sexual pleasure entirely — not just those experiencing active discomfort, but people who simply don’t feel much of anything anymore, or who have started avoiding intimacy altogether.
Dr. Litz has built her practice around exactly this population. Her PhD focused on human sexuality studies, and she has additional training in EMDR — eye movement desensitization and reprocessing — an evidence-based therapy developed for trauma that she finds particularly effective in pelvic discomfort cases.
Dr. Theresa Litz: “Something happens, and the body just starts to react. Even though you might be aware of it, and you’re like, ‘Why is this continuing to happen?’ — it helps to reduce some of that body activation that occurs.”
While Dr. Litz works with both men and women, she noted an important nuance worth naming: men and women navigate the healthcare system very differently when it comes to pelvic discomfort. Women are more frequently dismissed, told their symptoms are related to stress, or treated as a mental health concern before physical causes are fully ruled out. Men, in Dr. Litz’s observation, are more likely to have physical causes investigated first. This disparity shapes the therapeutic journey for each group in distinct ways.
What Sex Therapy Actually Is — And When to Seek It
Most people have significant misconceptions about what sex therapy involves. Dr. Litz is clear: it is talk therapy. Everything related to physical practice happens privately, as homework assigned between sessions — nothing occurs in the room. She often leads with her title of licensed clinical social worker before introducing her sex therapy specialization, simply because the label can feel intimidating before context is established.
More importantly, sex therapy is not narrowly focused. Dr. Litz shared a guiding principle she learned in graduate school that has stayed with her: sex therapy is very rarely a purely sex therapy case. Work stress, relationship dynamics, trauma history, sleep, and daily responsibilities all interconnect — and all of them can feed into the cycle that makes sexual pleasure feel out of reach.
So when should someone seek sex therapy? Dr. Litz’s answer: whenever you feel ready. Some specific prompts include hitting a wall in physical therapy despite structural progress, noticing you’re avoiding exercises your PT has assigned because they feel triggering or uncomfortable, feeling persistent guilt or shame around intimacy, or recognizing that your desire has dropped so low you’ve stopped feeling curious about physical closeness at all.
The Two Types of Desire (And Why Most People Only Know One)
One of the most practically useful parts of this conversation was Dr. Litz’s breakdown of spontaneous versus reactive desire — a distinction that reshapes how we understand “low libido.”
Spontaneous desire is what most people think of as normal: desire that simply arises on its own, without needing a particular context or stimulus. For some people, this is genuinely how they experience wanting intimacy. But for many others — and particularly for women managing full lives, stress, and daily responsibilities — desire is reactive. It doesn’t appear on its own. It emerges in response to presence, curiosity, and being in the moment.
Dr. Theresa Litz: “With that reactionary desire, if you have that curiosity to go into that sexual space, then the desire can increase naturally as you’re being present. But sometimes it can be very difficult, especially if that desire’s already low, to even have that curiosity to go into that space — especially if there are other factors making it feel uncomfortable.”
Understanding which type of desire a person experiences reframes “I never feel like it” from a dysfunction to a variation. And it clarifies why CBD, by helping lower the threshold of dread around entering that space, can play a meaningful role in reopening access to sexual pleasure.
How the Nervous System Gets Rewired — And What It Takes to Undo That
This is the part of the conversation that Tamar found most resonant — and arguably the most clinically important section of the episode.
When sex becomes repeatedly discomfort-causing, the nervous system doesn’t just file that experience away. It begins pattern-matching. A partner’s hug or kiss can start triggering a stress response — not because anything has happened yet, but because the brain has learned that physical affection leads to sex, which leads to discomfort. The alarm system starts firing early.
Sex is typically a parasympathetic nervous system response — rest, safety, presence. Chronic discomfort rewires it toward the sympathetic system — fight or flight, bracing, guarding. Tamar described this perfectly with the vaccination analogy: sitting in the chair, knowing the shot is coming, tensing the muscle until the nurse has to tell you three times to relax — and only then realizing just how braced the body had become.
That anticipatory guarding is often more activating than the discomfort itself. And it’s exactly what sex therapy, physical therapy, and CBD can work together to interrupt.
The Therapeutic Toolkit: Three Evidence-Based Approaches
Dr. Litz walked through the core techniques she draws from in her practice, describing each in accessible, practical terms.
Sensate focus is a structured approach used primarily with couples that removes penetration from the table entirely. Each partner takes turns being a giver and receiver of non-sexual touch, focusing on sensation — temperature, texture, pressure — rather than outcome. The goal is rebuilding presence and communication, not reaching a destination. It creates space to practice gentle redirection (“that didn’t feel great, but I really liked when you did this”), which translates directly into sexual assertiveness skills. For people with reactive desire, sensate focus also builds the anticipation and curiosity that invites desire to emerge naturally.
EMDR — eye movement desensitization and reprocessing — uses bilateral stimulation to reduce the nervous system’s activation around distressing memories or anticipated events. Dr. Litz uses it both to process past experiences (a traumatic event, a medical procedure whose side effects weren’t fully explained) and to do what she calls future targeting: addressing the anticipated discomfort around intimacy before it happens. For patients who have done a great deal of talk therapy without resolution, EMDR offers a different pathway that requires less verbal processing.
Mindfulness underpins almost everything else. Dr. Litz recommended a specific book — Better Sex Through Mindfulness: How Women Can Cultivate Desire — as a practical starting point for anyone not yet ready to pursue therapy or medical care. It addresses pelvic discomfort directly and includes guided meditations and body-awareness practices that can be done privately, at home, on the reader’s own timeline. For patients in the avoidance stage — where even the idea of exploring their body feels too charged — mindfulness and self-exploration (including gradual desensitization using a vibrator on non-genital areas first) can gently rebuild the mind-body connection without any external pressure.
Navigating Intimacy as a Couple: Guilt, Shame, and the Partner’s Role
When one partner is experiencing pelvic discomfort or low desire, the relational toll is real. Dr. Litz described the guilt cycle: the person with discomfort feels they are failing the relationship. The partner, often genuinely supportive, may be inadvertently communicating pressure without realizing it — simply by initiating affection that their partner has learned to associate with a discomfort response.
Tamar shared an observation from the endometriosis summits she attends: partners who show up to those conferences are extraordinarily committed. They’re present, supportive, absorbing everything they can. The issue isn’t willingness — it’s that no one has given them the roadmap.
Sex therapy with couples addresses this by reframing what intimacy can look like. Rather than a linear progression that ends in penetration and orgasm, Dr. Litz introduces what she calls a “pie” model — a variety of different types of physical connection, any one of which is complete on its own. Shifting to this non-linear model reduces pressure, opens up options, and often, paradoxically, makes the full range of sexual pleasure more accessible over time.
Dr. Litz also noted a gender difference worth flagging: women in her practice more often express guilt around intimacy — a sense of not meeting a relational obligation — while men more often experience pressure tied to societal performance expectations. For men whose pelvic discomfort came from an accident or injury rather than a longstanding condition, the therapeutic work often becomes about reconciling a past sexual identity with a present physical reality.
Where CBD Fits Into the Healing Process
Dr. Theresa Litz: “I feel like CBD would be like the little cherry on top that can really help with some of that relaxation — the piece that helps you actually get into that sexual space.”
Dr. Litz described CBD as working on the same core problem that all of her techniques address: the body’s learned tendency to brace, guard, and activate a stress response when sexual pleasure is approached. If mindfulness, sensate focus, and EMDR are the structural work, CBD is what helps lower the activation threshold so that structural work can actually land.
She shared a patient example that made this concrete: a client whose hormonal shifts limited their window for comfortable penetration to roughly one week per cycle. Using CBD suppositories alongside a vaginal moisturizer expanded that window considerably — removing the pressure of a narrow, high-stakes timeframe and creating more space for intimacy to develop naturally. The relief wasn’t just physical. The removal of that deadline reduced the psychological pressure as well.
Tamar addressed a concern Dr. Litz had heard from clinical colleagues: does CBD mask the severity of discomfort, potentially preventing people from seeking help when symptoms worsen? Her response, grounded in clinical experience: CBD dials discomfort down rather than numbing it out. About 70% of people who use MedRoots products for active pelvic discomfort report meaningful relief — and the typical description is that discomfort simply bothers and inhibits them less, not that they stop feeling it entirely. This is actually an advantage over pharmaceutical options like Valium or lidocaine, which can break the mind-muscle connection and prevent patients from sensing when they’re pushing past a safe threshold.
Tamar Hill: “I look at our CBD products — especially our suppositories and lubricants — as a tool to help sex therapists and PTs accomplish their work. Hopefully something manageable, and eventually something enjoyable.”
What to Expect: Honest Timelines and the Non-Linear Path
Both Dr. Litz and Tamar were clear about one thing: healing takes time, and it doesn’t move in a straight line. A principle Tamar has heard from other clinicians applies here — however long a condition has been present, expect at least that long to treat it.
Flare-ups will happen. A stressor in life, a hormonal shift, a triggering experience can bring symptoms back up temporarily. But Dr. Litz is careful to reframe what a flare-up means: it is not a return to square one. It is an opportunity to apply all the tools that have been developed — mindfulness, EMDR, movement, CBD, communication with a partner — to manage the wave rather than be swept under by it. Progress is measured in more time between difficult periods, not in permanent resolution after a single breakthrough.
Dr. Theresa Litz: “Everyone deserves to have that capacity for pleasure and to be able to engage in sex that feels good — and to define that on their own terms. If you are struggling with discomfort, it is possible to start working on those steps for sex to be more pleasurable. It just might take some time.”
You Deserve to Feel Good Again
If you’ve been living with pelvic discomfort that’s affecting your sexual pleasure, your relationship, or your relationship with your own body — know that recovery is possible, and you don’t have to navigate it alone. MedRoots offers CBD suppositories, vaginal moisturizers, lubricants, and pleasure-focused products designed to work alongside the care you’re receiving from your PT, sex therapist, and medical team. Our products are crafted to help you relax into the process — not numb out of it.
📞 Call us: 833-797-7576
🌐 Contact us online: medroots.com/pages/contact
Pleasure is within reach. Let’s help you get there.
This article is based on Episode 12 of Pelvic Pain Unpacked featuring Dr. Theresa Litz, PhD, licensed clinical social worker and sex therapist. Book mentioned: Better Sex Through Mindfulness: How Women Can Cultivate Desire. This article is for informational purposes only and does not constitute medical or therapeutic advice. Please consult a qualified healthcare provider before making changes to your treatment plan.