What do you do when the top specialist in the country tells you to prepare for a life of bed rest?
Sheren Gaulbert lived with vulvodynia for ten years, on escalating doses of amitriptyline, before an unlikely breakthrough with self-hypnosis got her out of the house within a week. She went on to train as a cognitive hypnotherapist and now works with people in chronic pain, combining hypnotherapy, EMDR and trauma-informed practice. She's also a trustee of the UK's Vulval Pain Society. In this episode, she and Mathilde talk about what actually happens in cognitive hypnotherapy, why pain science gets misunderstood, and why treating the whole person, not just the pain, changes everything.
Living with vulvodynia for a decade: why so many women are told there's nothing more to be done
Sheren's vulvodynia started in her early twenties, while she was at law school. What began as thrush-like symptoms that wouldn't clear up turned into a year-long diagnostic delay, then ten years of chronic pelvic pain so severe she blacked out from it. She was prescribed amitriptyline, a first-line treatment for vulvodynia, and eventually increased her dose to 95 milligrams, well above the typical range, without meaningful relief, just what she describes as a permanent fog.
The turning point wasn't a new treatment. It was a well-known NHS specialist telling her, almost in passing, that she wouldn't be seen again and should consider extended bed rest or a less stressful job. Sheren calls what happened next the nocebo effect: the specialist's words became a kind of self-fulfilling prophecy, and she spent years housebound as a result. It's a pattern she now sees constantly in her own clinical work, how much weight a clinician's offhand comment can carry for someone already in a vulnerable position.
It's hard to think about those years because it seems so far removed from where I am now. It's almost feels like a movie, like it's someone else, you know, that younger me lying in bed for hours and hours and hours.
What is cognitive hypnotherapy? Treating the whole person, not just the pain
Cognitive hypnotherapy has almost nothing in common with stage hypnosis. There's no script, no directive suggestion, no one being put "under". Instead, a cognitive hypnotherapist gets curious about how a specific person experiences their pain: what makes it better or worse, what beliefs they're carrying about their body, what behaviours or holding patterns might be feeding into it. For someone with vulvodynia or vestibulodynia, that might mean looking at how anticipating a painful event, like sitting through a long meal or lecture, changes the nervous system before anything has even happened.
Sheren describes hypnosis as something far more ordinary than people expect. Any time you do something automatically, like driving a familiar route without registering the journey, you're in a version of the trance state hypnotherapy works with. The job isn't to induce something exotic. It's to identify the "problem trance", the automatic loop of worry, prediction and bracing that keeps someone stuck, and help unwind it, at whatever pace suits that person's nervous system.
We're getting curious about the whole human being rather than the symptom. We're treating the person, not their pain.
Pain science, the biopsychosocial model and why chronic pelvic pain isn't "all in your head"
Sheren pushes back on a common misreading of pain science: that framing pain as biopsychosocial means treating it as psychological, or worse, imaginary. It doesn't. The biological piece is real, nervous system sensitisation, adrenaline, cortisol, and it interacts with psychological factors like belief and prior experience, and social factors like relationships and identity. None of the three can be separated out from the others, and none of them means the pain isn't real.
This matters practically, because predictive processing means the brain is constantly comparing new situations to old ones. If pelvic pain has shown up in a particular context before, like painful sex or sitting for long periods, the brain starts pre-loading a threat response before anything has actually happened, sensitising the nervous system in advance. Working with pain, in Sheren's model, means helping someone recognise that pattern and interrupt it rather than being carried along by it.
So clinicians like that who imply that you just need to do this, or it's all in your head, get rid of them, find someone else.
Getting help for vulvodynia: practical steps, quick wins and where to find support
Not every case needs years of therapy. Sheren shares the story of a woman who'd been in pain for over a year with no answers, and who found relief within two weeks simply by switching to non-biological laundry detergent, using an emollient instead of soap, wearing more breathable underwear, and getting assessed for HRT. If you haven't had a proper diagnosis yet, or haven't seen a gynaecologist, dermatologist or pelvic floor physiotherapist, that's the first step before anything else. Cognitive hypnotherapy and other trauma-informed approaches are appropriate for some people and not others, and timing matters as much as the approach itself.
What makes Sheren hopeful is simply that people are talking about vulvodynia and vulval pain more openly than they used to. Organisations like the Vulval Pain Society exist specifically to point people towards the right kind of clinician, whether that's a gynaecologist, a pelvic floor physiotherapist or a hypnotherapist, and towards other patients who've been through the same thing. If you're dealing with unexplained vulval or pelvic pain, start with a proper diagnosis, be selective about where you get your information, and don't accept "it's all in your head" as an answer.
