London: Persistent Female Pelvic Pain, Endometriosis & Sexual Function

2-Day Advanced Face-to-Face Female Pelvic Health Physiotherapy Course with Dr Alime Büyük

When standard pelvic health treatment isn’t enough…

What do you do when the usual pelvic health approach isn’t working?

What about the patient whose endometriosis still hurts after excision?

The patient whose scans are clear, but whose pain continues?

The patient with vulvodynia or sexual pain who cannot tolerate an internal examination, exercise programme or dilator?

Or the hypermobile patient who seems to flare after every treatment session?

These are often the patients for whom a standard pelvic floor protocol is simply not enough.

This advanced two-day, face-to-face course with Dr Alime Büyük is designed for pelvic health physiotherapists who already have foundation-level pelvic health knowledge and want to develop greater confidence in assessing, understanding and treating complex female pelvic pain presentations.

Rather than simply asking:

“What diagnosis does this patient have?”

Dr Alime will encourage delegates to ask:

“What is driving this patient’s symptoms — and what should I do next?”

What will you learn?

Across two intensive days, Dr Alime will explore:

• Persistent female pelvic pain
• Endometriosis and persistent pain following excision
• Chronic myofascial pelvic pain
• Myofascial, visceral, neuropathic and nociplastic pain mechanisms
• Female sexual function and sexual dysfunction
• Vulvodynia, provoked vestibulodynia and vaginismus
• Pelvic floor overactivity
• Hypermobility, HSD and hEDS
• Trauma-informed pelvic health assessment
• Vulval and pelvic floor examination
• Dilators, desensitisation and graded exposure
• Manual therapy and pelvic floor downtraining
• Transperineal ultrasound in assessment and rehabilitation
• Multidisciplinary referral and scope of practice

Why is this course different?

Mechanism-based, not simply diagnosis-led

Two patients can have exactly the same diagnosis and require completely different treatment.

Throughout the course, the emphasis will be on understanding what may be driving the individual patient’s symptoms and using this clinical reasoning to decide what to do next.

Endometriosis through a physiotherapy lens

Why can pain continue even after successful endometriosis surgery?

Explore the lesion–pain mismatch, sensitisation, myofascial contributions and the role physiotherapy can play in persistent symptoms.

Just as importantly, learn to recognise when physiotherapy may not be the answer and when referral back to gynaecology or another specialist is more appropriate.

Sexual function as a core pelvic health outcome

Develop greater confidence discussing:

• Desire
• Arousal
• Orgasm
• Dyspareunia
• Sexual pain
• Hormonal influences
• Medication
• Menopause
• Body image
• Relationship and partner factors

The course will explore not only what physiotherapists can contribute, but also scope of practice and when psychosexual or medical referral should form part of the patient’s management.

Vulval pain explored in depth

Build your clinical reasoning around:

• Vulvodynia
• Provoked vestibulodynia
• Vaginismus
• Muscular presentations
• Hormonally mediated presentations
• Neuroproliferative presentations
• Inflammatory presentations

The course will also consider important differential diagnoses and appropriate medical co-management.

Hypermobility, HSD & hEDS

Why do some hypermobile patients respond poorly to conventional pelvic health treatment?

Explore how prolapse, urinary and bowel dysfunction, dyspareunia, proprioception, dysautonomia, gut dysmotility, load tolerance and pacing can influence rehabilitation — and why standard strengthening or manual therapy dosages can sometimes flare these patients.

A genuinely practical course

This is not two days of lectures.

Practical teaching will include:

• Abdominal wall and scar assessment
• Scar mobilisation
• Diaphragm and rib-cage assessment
• Hip and obturator assessment
• Carnett’s test
• Vulval assessment
• Cotton-swab / Q-tip testing
• Pain mapping and sensory testing
• Internal pelvic floor examination
• Layer-by-layer pelvic floor palpation
• Assessment of tone, relaxation and contractility
• Trigger-point assessment and treatment
• Obturator internus and levator ani techniques
• Pelvic floor downtraining
• Dilator programmes
• Desensitisation
• Graded exposure
• Designing realistic home programmes

Internal peer examination is entirely optional and opt-in.

Delegates who do not wish to participate in internal peer examination can follow an alternative simulation/model-based learning pathway.

Day One

Persistent Pelvic Pain, Endometriosis & Myofascial Pain

Day One establishes the clinical reasoning framework for understanding complex pelvic pain.

Topics include:

Anatomy & Terminology Refresher

A focused refresher covering pelvic floor layers, pudendal and obturator anatomy, vulval and vestibular anatomy, pelvic floor tone, provoked versus unprovoked pain and nociplastic terminology.

Mechanisms First

Explore nociceptive, neuropathic, nociplastic and visceral pain, central sensitisation and viscero-somatic convergence — and understand why the same diagnosis may require very different treatment in different patients.

Endometriosis for the Physiotherapist

Including pathophysiology, symptoms beyond dysmenorrhoea, the lesion–pain mismatch, medical and surgical management, physiotherapy timing, persistent pain following surgery, myofascial contributions, fertility conversations and referral pathways.

The Pelvic Pain Subjective Examination

Develop a structured approach to history taking, sexual-function conversations, trauma-informed practice, bladder and bowel symptoms, IBS overlap, inclusive language and outcome measures.

Chronic Myofascial Pelvic Pain

Explore the contribution of the obturator internus, levator ani, coccygeus, piriformis and abdominal wall, alongside breathing, posture, load, scars and post-surgical presentations.

The afternoon moves into extensive practical assessment and treatment, including external and internal pelvic pain assessment.

Day Two

Sexual Function, Vulval Pain & The Hypermobile Patient

Day Two develops these principles further through some of the most challenging presentations encountered in pelvic health practice.

Female Sexual Dysfunction

Explore contemporary female sexual response models and the interaction between desire, arousal, orgasm, pain, hormones, menopause, medication, body image and relationship factors.

Importantly, learn how to have these conversations confidently and how to document them appropriately.

Vulvodynia, Vestibulodynia & Vaginismus

Develop your understanding of classification, differential diagnosis, pelvic floor involvement and muscular, hormonal, neuroproliferative and inflammatory presentations.

Practical Vulval & Vestibular Assessment

Including vulval inspection, cotton-swab/Q-tip testing, pain mapping, sensory testing, documentation, dilator prescription and progression, desensitisation and graded exposure.

Hypermobility, HSD & hEDS in Pelvic Health

Explore screening principles and the relationship between hypermobility and prolapse, urinary dysfunction, bowel dysfunction, dyspareunia, PoTS/dysautonomia, gut dysmotility, proprioception and treatment tolerance.

Clinical Reasoning Workshop

Put everything together by working through complex patient presentations in small groups.

Delegates will consider:

• Key clinical problems
• Possible mechanisms
• Treatment priorities
• Referral requirements
• What they would actually do during the patient’s first three treatment sessions

The course concludes by examining scope, referral and service design, including working with gynaecology, dermatology, pain services and psychosexual therapy, alongside documentation, medico-legal considerations and intimate-examination governance.

Who is this course for?

This course is aimed at pelvic health physiotherapists who already have foundation-level pelvic health knowledge and want to progress beyond standard treatment protocols.

It will be particularly relevant if you regularly see patients with:

• Endometriosis
• Persistent pelvic pain
• Painful intimacy
• Vulval pain
• Pelvic floor overactivity
• Hypermobility or hEDS
• Persistent symptoms following surgery
• Complex or overlapping pelvic health presentations

This is an advanced course rather than an introduction to pelvic health physiotherapy.

The question we want you to leave able to answer

Not simply:

“What diagnosis does this patient have?”

But:

“What is driving this patient’s symptoms — and what should I do next?”