You’re Not “Too Sensitive”—Why Endo Pain Is Real and Valid

Dr. Sasha Speer, PT, DPT
Sep 4
5 min read

If you’ve ever been told your period pain is “normal,” that you just have a "low pain tolerance" or that it’s all in your head—this post is for you.

Endometriosis (endo) pain is real, complex, and far too often dismissed. At Auria Pelvic Health, we see patients every week who have spent years—sometimes a decade or more—seeking answers for severe pelvic, abdominal, or back pain that disrupts school, work, intimacy, and everyday life. Many were told they were “too sensitive.” None of them were.

Let’s break down what’s really going on in the body with endometriosis, why the pain experience can be so intense, and how pelvic floor physical therapy can be a powerful part of your care team.

Quick Refresher: What Is Endometriosis?

Endometriosis is a condition in which tissue similar to (not identical to) the lining of the uterus is found outside the uterus—often on the ovaries, fallopian tubes, bladder, bowel, pelvic walls, or even beyond the pelvis in rarer cases. These lesions can respond to hormonal changes, become inflamed, form adhesions (sticky scar-like bands), and irritate surrounding nerves and tissues.

The result? Pain that can show up in multiple ways—not just during your period.

Common symptoms can include:

Severe menstrual cramps that don’t respond well to typical pain relief
Pelvic pain at other times in the cycle (mid-cycle, pre-period, or constant)
Pain with sex (often with deep penetration)
Pain with bowel movements or urination, especially around your period
Bloating, abdominal pressure, or “endo belly”
Low back, hip, or tailbone pain that seems hormonally linked
Fatigue (pain is exhausting!)

“Am I Just Sensitive?”—Understanding Pain Amplification

Here’s the truth: feeling a lot of pain does not mean you’re weak. Pain is an output of the nervous system—a protective alarm that gets louder when your body perceives threat or repeated irritation.

With endometriosis, several overlapping factors can amplify pain signals:

1. Inflammation from Lesions

Endo lesions can trigger inflammatory chemicals that sensitize nearby nerves, making tissues more reactive to pressure, stretching, or hormonal shifts.

2. Adhesions & Restricted Mobility

Scar-like adhesions can limit how organs and tissues glide past one another. When movement is restricted (think: bowel loops tugging, bladder filling, or uterine movement), pain can spike.

3. Peripheral Sensitization

Nerves near irritated tissues can become hyper-responsive—sending stronger or more frequent pain signals.

4. Central Sensitization

Over time, the spinal cord and brain can “turn up the volume” on pain pathways, so stimuli that used to feel mildly uncomfortable now feel severe. This is not imagined—it’s a well-recognized neurophysiological process in chronic pain.

5. Protective Muscle Guarding

When something hurts, nearby muscles often tighten to guard the area. In the pelvis, that can mean pelvic floor overactivity, abdominal bracing, or glutes that never fully relax. Chronic tension then becomes its own source of pain.

Bottom line: You are not “too sensitive.” Your body is responding to real drivers—some in the tissues, some in the nervous system, and some in the way the body has adapted over time.

Why Endo Pain Gets Dismissed So Often

If your pain has been brushed off, you are (unfortunately) in crowded company. Several systemic issues contribute:

Normalization of severe period pain: Many people are taught from a young age that bad cramps are just part of having a uterus.
Gender and bias in medicine: Research shows that women and people assigned female at birth are more likely to have pain discounted or under treated.
Invisible symptoms: Imaging doesn’t always show endo clearly; a definitive diagnosis often requires laparoscopy, which may be delayed.
Symptom overlap: IBS, interstitial cystitis, pelvic floor dysfunction, and musculoskeletal pain can coexist and blur the diagnostic picture.

Your pain story matters—even when lab results look “normal.”

How Pelvic Floor Physical Therapy Helps with Endo

While pelvic floor PT does not cure endometriosis (surgical excision is currently the gold standard for removing lesions), it can dramatically improve quality of life by addressing the secondary drivers of pain, function, and mobility.

What We Work On in Pelvic PT for Endo

1. Pelvic Floor Muscle Tension & Trigger Points

Chronic guarding can lead to tight, tender, or overactive pelvic floor muscles that contribute to pain with sex, tampons, or exams—and even to urinary urgency.

2. Breathing & Diaphragm Coordination

Restoring diaphragm-pelvic floor rhythm helps reduce tension and improve pressure management in the abdomen.

3. Visceral & Myofascial Mobility

Gentle hands-on techniques help tissues and organs glide more freely, reducing pulling pain with movement, bowel function, or menstrual changes.

4. Bowel & Bladder Strategies

Positioning, urge suppression tools, dietary triggers, and fiber/fluid balance can reduce symptom flares, especially when bowel or bladder involvement is part of your pattern.

5. Graded Movement & Activity Planning

We help you return to the movement you love—walking, Pilates, lifting, yoga—without triggering flares. Smart pacing builds confidence.

6. Nervous System Down-Regulation

Pain amplifies when the nervous system runs “hot.” We teach relaxation, body scanning, pelvic drops, and somatic techniques to help shift out of constant high alert.

Myth vs. Truth: Quick Hits

Myth: Bad cramps are just part of life.

Truth: Severe or disabling pain deserves evaluation.

Myth: If imaging is normal, you’re fine.

Truth: Endo doesn’t always show up on imaging; symptoms still matter.

Myth: You missed your window—if it’s been years, nothing will help.

Truth: It is never too late to get support and make meaningful progress.

Self-Advocacy: Talking to Your Provider About Endo Pain

Bring notes. Be specific. Use functional language—what pain keeps you from doing.

Try phrases like:

“My period pain causes me to miss work/school at least X days a month.”

“Intercourse is painful at X depth or position.”

“Bowel movements are painful around my period; I brace and sometimes cry.”

“Pain wakes me at night even with medication.”

Ask directly: “Could this be endometriosis?” and “Can you refer me to a pelvic floor physical therapist or endometriosis specialist?” If you are still being dismissed, get a second opinion from another provider.

Everyday Strategies to Support Your Body (While You Seek Care)

These are not cures—but they can help you cope, reduce flares, and feel more in control:

Heat therapy: Warm packs or a heated rice sock across the lower abdomen or back.
Supported rest positions: Child’s pose over stacked pillows, reclined butterfly, or side-lying with a pillow between knees.
Gentle pelvic drops + exhale breathing: Inhale wide into ribs; exhale and imagine pelvic tension melting.
Bowel basics: Don’t ignore urges; use a footstool; breathe—don’t strain.
Anti-inflammatory nourishment: Colorful produce, balanced fats, hydration; track what seems to trigger flares.
Movement in minutes: Even 5–10 minutes of walking, floor mobility, or stretching counts—and may help circulation and mood.
Stress buffering: Guided relaxation, mindfulness apps, nervous-system calming practices (down-reg breathing, vagus-nerve-friendly humming or singing).

When to Seek Urgent or Prompt Medical Care

Contact a healthcare provider promptly if you experience:

Sudden, severe pelvic or abdominal pain that is new or worsening
Fever with pelvic pain
Inability to keep fluids down with pain (risk of dehydration)
Symptoms of bowel obstruction (no gas or stool + severe bloating/pain)

When in doubt, get checked. You are not overreacting.

You Deserve to Be Believed

Living with endometriosis-related pain can be isolating—but you don’t have to navigate it alone. Whether you’re newly suspicious of endo, recovering from surgery, or managing long-term symptoms, multidisciplinary care works best: gynecology or endo-excision specialist, pelvic floor PT, pain management, nutrition, and mental/emotional support.

At Auria Pelvic Health, we meet you where you are—with compassion, evidence-informed care, and practical tools you can use right away.

Ready to Take the Next Step?

Not sure if your symptoms point to endo? Let’s talk it through.

Already diagnosed? We can help you build a pelvic plan that supports your surgical care and long-term function.

Trying to be heard? We’ll help you prepare language for your medical visits.

Call our clinic to see if pelvic floor PT may be able to help you.

Auria Pelvic Health

8929 S Sepulveda Blvd., Ste. 412

Los Angeles, CA 90045

Phone: 213-699-3996

Website: www.theaurialife.com