Shame and Your Pelvis: How to Overcome The Biggest Barrier to Healing Your Pelvic Floor

By Addy Sonneland, AMFT

You know you need pelvic floor therapy, yet something keeps holding you back– you can’t get yourself to make that first phone call, or maybe you did schedule that first phone call but now can’t bring yourself to go. When you even think about talking about your pain with a pelvic floor specialist, you freeze up. You just want to run in the opposite direction.

Shame can be a powerful barrier to the healing process. Shame often operates quietly in the background, whispering doubts like

“I should be able to handle this on my own”
“I shouldn’t need help”
“I shouldn’t be struggling with this ”

Sometimes we are aware of shame, but sometimes shame subtly holds us back, hovering on the fringes of our awareness.

Shame lives in our bodies long before we have a conscious thought to back it up. We might not even be able to name a reason we feel hesitation about sharing our pain or having someone help us with our bodies. Yet the hesitation is powerful, and it keeps us from getting the help we need.

In this blog, we will talk about how shame prevents us from benefiting from pelvic floor therapy, how to recognize shame’s presence, and two practical strategies to work through shame so you can step into healing with gentle self compassion.

What is Shame?

Shame is a social emotion first felt in childhood. Often it happens when we’re rejected based on some behavior or difference we can’t avoid. Some of our most powerful feelings of shame come from our own families. Certain behaviors, emotions, or parts of us are seen as unacceptable.

We hide, we try to stop, because we don’t want to be cast out. We all know what this feels like, how much rejection makes us want to hide and change ourselves. 

In our adult lives, these early fears can still glow red-hot. In a moment where we worry we’ll be rejected, we preemptively turn the blame inward, convincing ourselves that we are the cause of our own suffering. We learn to tell ourselves we are inadequate, broken, flawed, or unacceptable.

The Pelvic Floor Is a Common Area for Shame

It’s common to feel shame at parts of our bodies. Cultural and personal beliefs often label topics like pelvic health, trauma, and bodily functions as "taboo," creating an environment where shame can take hold and distance us from self-compassion.

If shame about our bodies is a common experience, shame about the pelvic area is not only common, but incredibly intense. Shame around the pelvic floor is amplified by lack of open conversation, cultural and societal taboos, misinformation and stigma, and ties to identify and self-worth. Topics like sexual dysfunction, postpartum recovery, and urinary incontinence are rarely discussed openly, leading to isolation and embarrassment around common pelvic floor issues. Additionally, cultural and societal associations with pelvic health include weakness, aging, or loss of control. These associations reinforce the idea that discussing the pelvic floor is inappropriate or shameful. Myths around the pelvic floor can also prevent people from seeking help. Perhaps most powerful are the ties to identity and self-worth. Issues in the pelvic floor can trigger feelings of inadequacy, lack of confidence, and bring up past traumatic events. We not only store shame in our emotional life, but also in our bodies. We call these sensations, “somatic expressions” of shame.

Common somatic expressions of shame include:

● Tightness in the chest, jaw, or throat
● Holding tension in the pelvic floor, stomach, or shoulders
● Collapsing posture (i.e. making your body smaller)
● Avoiding eye contact
● Sensations of nausea, flashes of heat, or cramping in the gut

How Shame Impacts Pelvic Floor Treatment

When we get close to sources of shame, we experience the natural, internal reaction of feeling exposed or vulnerable. Other people are seeing the parts of ourselves that we would rather keep hidden. This discomfort can manifest in avoidance behaviors, such as avoiding pelvic floor treatment, missing appointments, or neglecting prescribed exercises. Shame often speaks in thoughts like,

“I shouldn’t need this”,
“They shouldn’t have to help me”
“This is embarrassing”,
“I am too far gone",
“I’m gross or undeserving”,
“I did this to myself”, or
“I don’t even want to think about it”

Shame tells us to distance ourselves from others and to minimize our experiences. This can look like:

● Withdrawing from sources of support
● Cancelling appointments
● Overcompensating with perfectionism or self-criticism
● Avoid exercises or therapy homework
● Minimizing the pain or discomfort

The result? Shame causes you to avoid help, shrinking your world and increasing your pain. This is a problem for your pelvic floor.

In fact, shame is likely the central obstacle keeping you from healing. You may rationally know that pelvic floor therapists have helped many people like you, and that they’ve seen everything before, but emotionally, your shame is holding you down like a net. Let’s help you untangle yourself so you can actually heal and grow:

Two Tips for Managing Shame

1. “Name it to Tame it”: This mantra, developed by Dr. Dan Siegel, emphasizes the power of regulating emotions through verbal acknowledgment. This approach is particularly valuable when managing shame, an emotion that thrives in secrecy and avoidance.

Shame often operates in the background, influencing thoughts and behaviors without being fully recognized. When we experience shame, the brain’s limbic system reacts as if we are under threat, resulting in an automatic response in the nervous system. This can look like avoidance behaviors, emotional shut downs, or functional freezing.

When we name the emotion– for example, “I am feeling shame right now because I’m worried what they will think about me”-- we engage the prefrontal cortex. This part of our brain is responsible for rational thought and emotional regulation. When we involve the prefrontal cortex, we calm the threat response and respond with greater self-awareness and regulation.

2. Somatic awareness involves tuning into the physical sensations of your body and responding with care. Shame most often manifests physically (examples: tightness in the chest, a pit in the stomach, lump in the throat). A key practice in somatic awareness is noticing areas of tension and then intentionally softening them. This could involve taking deep breaths to relax clenched muscles, gently stretching tight areas, or placing a hand over the heart or abdomen as a gesture of self-soothing. By actively engaging the body in this way, we signal to the nervous system that we are safe, helping to regulate emotional responses and shift away from shame-based patterns.

What if I’m Uncomfortable or Embarrassed?

When we activate ourselves to address deeply personal issues like pelvic health or trauma, it is natural to feel exposed. Discomfort doesn’t mean you are doing something wrong. Rather, it is your body letting you know that you are doing something new. It’s a sign that you are trying something new and defying the isolation that shame put you in. Just like strengthening your body, it includes some soreness or fatigue.

Emotional healing involves moments of discomfort to work through the vulnerability. Over time, as you handle these feelings gently and with care you will find yourself on the path to greater healing and ease within your mind and body.

The pelvic floor therapists at The Pelvic Model know what it’s like to feel uncomfortable and to need to dip your toe in slowly. That kind of care helps you establish trust and begin to heal. Tell your physical therapist about your uneasiness and shame so they can help you.

Healing Happens in Relationship

We are rarely able to work through shame on our own. Shame loses its power when we have new experiences in safe relationships with other people. Skilled professionals can create a safe, judgement free space where you have a person with you to accompany you through areas of vulnerability. The more you bring shame into the open with another person, the less power it holds over you.

Working with your pelvic floor can bring up powerful memories attached to shame. It can activate emotions that have needed to be expressed and processed for years. As a somatic therapist, I’m here if you need help processing through those important experiences to create freedom from shame and anxiety.

Conclusion

While shame is a common experience for many people, it is a barrier that can be overcome with self-compassion, a safe relationship, and somatic awareness. You don’t have to overcome shame alone, doing the work with a trusted professional can be one of the most transformative parts of healing.

If we’re courageous enough to explore our shame, we’ll find the biggest opportunities for our healing.

Addy Sonneland, AMFT
Somatic Therapy in Pasadena
Here Counseling