Vulvodynia and Pelvic Pain: Is It Tension Myositis Syndrome, Neuroplastic Pain, or Mind Body Syndrome?

By Lorraine


Are you suffering with chronic pelvic pain including pain or burning during sex, vulvodynia, pelvic floor dysfunction, interstitial cystitis, pudendal neuralgia, persistent pain after UTIs or yeast infections, irritable bowel syndrome or endometriosis?

Have you been to numerous doctors, specialists, physical therapists, and alternative health practitioners, spent thousands of dollars, and ended up getting nowhere?

Understanding pelvic pain can be a difficult process. Sometimes doctors will even tell you that there’s nothing wrong or that your symptoms are “all in your head?”

If so, your vulvodynia or pelvic pain symptoms may be Mind Body Syndrome, also known as Tension Myositis Syndrome (TMS), or neuroplastic pain and the next step is to understand what this means and how to know if your pain is mind-body.

Pelvic Pain: What is Tension Myositis Syndrome (TMS)/ Mind Body Syndrome (MBS)/ or Neuroplastic Pain?

I first learned about Tension Myositis Syndrome (TMS) and Mind Body Syndrome (MBS) after relieving vulvodynia myself using a mind-body approach.

The term “mind-body pain” can mean a lot of different things, but in general, it refers to the complex and interconnected relationship between mental and emotional factors and physical pain. It recognizes that mind-body factors like our thoughts, emotions, stress, trauma, and life experiences, impact our brain, nervous system, and physiology, and therefore can cause or contribute to pain. You may have had a doctor or physical therapist mention central sensitization, neuroplastic pain, or psychosocial factors for your pain. If so, they are referring to mind-body pain.

Tension Myositis Syndrome (TMS) is a diagnosis that was developed by Dr. John Sarno, physician, professor of Rehabilitation Medicine, and author of many books including Healing Back Pain.

Dr. Sarno teaches that pain and other symptoms can be created by the brain as a distraction from underlying emotions that the brain perceives as “threatening.” To relieve this kind of pain, he recommended patients take their attention off of their symptoms and “think emotional”–- For example, when symptoms flare up, rather than worry or catastrophize, ask yourself what is going on emotionally for you outside of your symptoms, and bring your attention to that. According to Dr. Sarno, your brains avoidance of that emotion is the real root cause of the pain.

With this technique, Dr. Sarno had incredibly high success rates helping patients relieve chronic back pain and other chronic pain syndromes without physical interventions like surgery or physical therapy.

Since then, many other doctors have studied the work of Dr. Sarno, including Dr. Howard Schubiner, author of Unlearn Your Pain, who coined the term Mind Body Syndrome for neural pathway pain (nerve pain) and how the brain learns pain (neuroplastic pain).

In addition to Dr. Sarno and Dr. Schubiner, other doctors in the field of mind-body medicine, including Dr. Gabor Mate, author of When the Body Says No, and Dr. Lissa Rankin, author of Mind Over Medicine, emphasize the mind body connection and how psychological, social, and emotional factors can influence physical health and cause or contribute to all kinds of disease including autoimmune disease and cancer.

In the realm of pelvic pain, vulvodynia, painful sex, and other pelvic health issues affecting women and people with vaginas––I first began researching and developing solutions for people to find relief well over 12 years ago. Over this time, I’ve helped over 1,000 vulva-owners relieve their symptoms through the mind-body techniques in my Healing Female Pain Program.

In the past 10 years, research in the fields of mind-body medicine and pain neuroscience has exploded. We now know that all pain is created in the brain, independent of whether or not there is something physically wrong in the body. Study after study confirms that stress, trauma, and emotions impact our nervous system, endocrine system (hormones), musculoskeletal system (muscle tension), immune system, reproductive and digestive systems, all playing a role in chronic pelvic and sexual pain.

What this means is that if you are trying to relieve vulvodynia or other chronic pelvic pain, without addressing the mind-body components, you are missing a big piece of the pain relief puzzle, and it is unlikely to be successful. So many of my clients have tried everything and not been able to find relief until they use a mind-body pain relief approach.

So how do you know if a mind-body approach will help you relieve your pelvic pain?

How do I know if my pelvic pain symptoms are TMS or Mind Body Syndrome?

First, know that most chronic pain is mind-body/neuroplastic in nature. Even when there is a physical issue (like pelvic floor tension, hormone imbalance, endometrial lesions, or previous injury), all pain is created in the brain. Pain is a danger response mechanism that can be activated by mental, emotional, and social factors, and it is important to address this aspect of pain, even when there are contributing physical issues.

That said, there are ways to diagnose TMS/brain-induced/ neural pathway pain. One way that I find very helpful is the following 2-step method developed by Dr. Howard Schubiner.

2 steps to Diagnose a Mind Body Syndrome/ TMS/ Neural Circuit Disorder/ Brain Induced Pain….

  1. Rule out a Structural Disorder
  2. Rule in a Neural Circuit Disorder

Step 1: Rule out a Structural Disorder

If you’re experiencing pelvic or sexual pain you want to first work with your doctor to rule out a structural disorder, like an active infection, cancer, severe prolapse, arthritis causing significant limitations in movement, or a broken bone.

It can be tricky for women with pelvic and sexual pain to sort out what is structural pain and what is not, because there are so often physical changes happening at the same time that there is pain, and because pelvic pain (like other types of mind-body pain) can often start after an injury, physical trauma or infection.

It’s important to know that many “structural issues” like muscle tension, pelvic or spinal misalignment, even most arthritis or mild prolapse is not necessarily considered to be a structural disorder in the TMS approach, as these issues are often not the cause of pain.

Many of these findings, including degenerative disc disease, bulging discs, and pelvic muscle tension are normal findings even for people who do not have pain. Just because a physical issue exists does not mean it is the cause of the pain. For example, many women with pelvic floor tension, or who are past menopause do not experience pain or burning during sex.

According to Dr. Howard Schubiner, almost any symptom can be caused by neural circuits (brain-induced), and almost any symptom can also be caused by a structural disorder. So even if you have some structural issues, outside of things that need immediate medical attention, like an active infection, cancer, a recent injury, or an abnormal neurological exam, your pain may be fully or partly neural pathway pain.

The next step to “rule in” a mind body syndrome or neural circuit disorder (ie. brain induced pain).

Step 2: Rule in a Neural Circuit Disorder

There are 2 ways to rule in mind-body syndrome/ TMS/ neural pathway pain.

First, look at the Circumstantial Evidence.

Circumstantial evidence gives us clues that there may be mind-body factors causing or contributing to your pain, that the pain is not coming from your body, and that a mind body approach will help you relieve it.

If you’ve experienced or relate to one or more of the following, this is circumstantial evidence that your vulvodynia or pelvic pain symptoms may be mind-body syndrome, neuroplastic pain, or TMS…

  • You have had a history of different types of mysterious pain or health issues at different points in your life.
  • You would describe yourself as a type A personality. Maybe, like most of my clients, you are a perfectionist, a high achiever, overly responsible, a people pleaser, very self-critical or hard on yourself, always trying to do things right. Dr. Sarno called this personality type a “goodist”.
  • You had a stressful or emotional experience (or a series of stressful or emotional experiences) preceding the onset of your pain. For example, you experienced a significant loss, a move, a trauma or career change, or you were having significant work, parenting, relationship, or other stress.
  • You’ve had childhood trauma or Adverse Childhood Experiences, or experienced a lot of pressure as a child.
  • You’ve struggled with having a healthy relationship with sex and pleasure, experienced shameful or negative family or religious conditioning around your sexuality, or have had negative past experiences, fear or confusion. (In my experience most women are dealing with some level of shame and negative conditioning around their sexuality).
  • You struggle with fear, catastrophizing and/or anxiety.
  • You struggle with emotions. Either you have difficulty expressing your emotions or knowing what you’re feeling, or you feel “too emotional” or like you’re too much. You also may have a hard time setting boundaries (or feel guilt or fear when you do) and/or put everyone else’s needs before your own.

Next, Look at How the Pain Itself behaves. This is CONFIRMATORY evidence.

The following is the FIT assessment developed by Dr. Howard Schubiner. This assessment looks at how your pain behaves to determine if it is mind-body pain.

Read through the following carefully. If you answer yes to even one of the following criteria, that is confirmatory evidence that you have TMS or Mind Body Syndrome and that a mind-body approach will help.


  • Symptoms began without a physical precipitation
  • Symptoms persist after an injury has healed
  • Symptoms are in a distribution pattern that is symmetric
  • Symptoms occur on one whole side of your body or occur on half of your face, head, or torso
  • Symptoms spread over time to different areas of your body
  • Symptoms radiate to the opposite side of your body or down a whole leg or arm
  • Symptoms occur in many different body parts at the same time
  • Symptoms have a quality of tingling, electric, burning, numb, hot or cold


  • Symptoms shift from one location in your body to another
  • Symptoms are more or less intense depending on the time of day or occur first thing in the morning or in the middle of the night
  • Symptoms occur after, but not during, an activity or exercise
  • Symptoms occur when you think about them or when someone asks you about them
  • Symptoms occur when stress increases or you think about stressful situations
  • Symptoms are minimal or nonexistent when you are engaged in joyful or distracting activities, such as when you are on vacation
  • Symptoms are minimal or nonexistent after some kind of therapy, such as massage, chiropractic, Reiki, acupuncture, an herbal or vitamin supplement


  • Symptoms are triggered by things that are not related to the actual symptoms, such as foods, smells, sounds, light, computer screens, menses, changes in the weather
  • Symptoms are triggered by the anticipation of stress, such as prior to school, work, a doctor’s visit, a medical test, a visit to a relative, or a social gathering; or during those activities
  • Symptoms that are triggered by simply imagining engaging in the triggering activity such as having sex, sitting or walking
  • Symptoms that are triggered by light touch or innocuous stimuli, such as the wind or cold

Do your symptoms behave in any of the above ways?

Remember, if even one of these 19 criteria fits your experience with your pain, it means that your pain or other symptoms are coming from neural circuits in your brain and NOT a structural issue in your body. There is nothing wrong with your body.

The reason this assessment is confirmatory for neural pathway pain or Mind Body Syndrome is that pain from a structural issue does not behave in these ways. For example, pain from a broken bone or torn ligament happens during activity, not AFTER activity. These are characteristics of pain that are coming from neural pathways in your brain.

And that is really good news, because it means that even if nothing has worked until now, you can relieve your pain using a mind-body approach! You just need the right tools and support to help you do it.

What’s Next?

Many women write to me to tell me they have relieved their pain using the information on my website and blog alone. A great place to start is with my upcoming Free training, Say Goodbye to Pelvic Pain.

If you would like to fast-track your recovery, I have two options available for women and people with vaginas.

Pelvic Pain Relief Coaching: Apply for a free consultation here: I offer 3 and 6-month private coaching programs.

The Healing Female Pain Program: My 12-week pain relief program will walk you step by step through the process of relieving vulvodynia, painful sex, pelvic floor dysfunction, IC, PN and other pelvic and sexual pain using a mind-body approach. Click here to learn more about the Healing Female Pain program

Say Goodbye To Pelvic Pain! Sign Up for my

FREE, LIVE Training on February 13.


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