Paula Kirsch, LCSW, P-CST, CST

Sexual Pain and Pelvic Pain Vaginismus, dyspareunia, and pelvic pain are among the most undertreated issues in women's health not because solutions don't exist, but because so few providers are trained to address the emotional and psychological dimensions alongside the physical. I work with women navigating these conditions, often in collaboration with pelvic floor physical therapists, to address the shame, anxiety, trauma, and fear that physical treatment alone cannot reach. Women's Sexual Health Across the Lifespan Desire, arousal, and intimacy don't expire ? but they do change. I work with women navigating low desire, postpartum sexual changes, menopause, and the complex ways that identity and body image intersect with sexual wellbeing at every stage of life. Relationship and Couples Issues Desire discrepancy, communication breakdown, infidelity, and intimacy disconnection are at the center of much of my couples work. I use the Gottman Method because it gives couples real tools grounded in decades of research ? not just insight, but actual skills they can use. LGBTQ+ Affirming Care All gender identities, sexual orientations, and relationship structures are welcome here without explanation or justification. I understand minority stress and the particular exhaustion of having to educate your therapist before the work can begin. We can skip that part. Kink, Polyamory, and Ethical Non-Monogamy Whether you are monogamous, polyamorous, kinky, or still figuring it out, you won't spend session time defending your relationship structure. I am informed and affirming across the full spectrum of consensual relationship dynamics.

I didn't come to this work from the outside looking in. I grew up in a home with domestic violence which meant I learned early, and out of necessity, how to read relationships, how to find safety in understanding what was really happening beneath the surface, and how much it matters to have someone in your corner who genuinely gets it. As an adult I found myself in a marriage that slowly took up all the oxygen. My own goals, my own growth, my own sense of who I was; there wasn't room for any of it. Getting out was one of the hardest things I've ever done. During that time I worked with a therapist who was truly remarkable, and that experience showed me from the inside what good therapy can actually do. It wasn't just helpful, it was clarifying in a way that changed the direction of my life. That's when I knew what I wanted to do. I think clients can feel the difference between a therapist who understands struggle intellectually and one who has actually lived inside it. I'm not going to pathologize your pain or rush you toward resolution. I know what it feels like to carry something heavy for a long time before finally being ready to put it down. I also know what it feels like to build something on the other side of that: a life, a practice, a sense of self that actually fits. That's what I want for the people I work with. Not just the absence of the problem, but something worth moving toward.