“A Glass of Wine” Not Cutting It – Painful Intercourse in Younger Women

Sexual pain in pre-menopausal women, particularly those in their 20s and 30s, remains widely underdiagnosed, undertreated, and frequently minimized. This session challenges that narrative by equipping pelvic health physical therapists with a rigorous, impairment-based framework for evaluation and intervention.

Attendees will develop the clinical reasoning skills to distinguish among the most common mechanical contributors to sexual dysfunction: vulvodynia (provoked and spontaneous), vaginismus/pelvic floor hypertonicity, and dyspareunia rooted in structural, myofascial, or neurological impairments. Using case based illustrations, the presentation will walk clinicians through a systematic musculoskeletal and neuromuscular examination approach that identifies the primary impairment driving the patient's pain.

From there, the session pivots to practical application—presenting a priority-based treatment framework that maps specific interventions to specific impairments, including manual therapy, progressive desensitization, neuromuscular re-education, pain education, and interdisciplinary co-management strategies. Patient goals, psychosocial context, and readiness will be integrated throughout to model a whole-person approach.

Participants will leave with concrete, immediately applicable clinical tools to better serve this underserved population.

1. Differentiate among vulvodynia, vaginismus, and dyspareunia by applying evidence-based diagnostic criteria and musculoskeletal examination findings within the scope of pelvic health physical therapy practice.
2. Prioritize treatment interventions based on primary impairments identified during examination, including pelvic floor hypertonicity, connective tissue restrictions, neurodynamic sensitization, and central sensitization.
3. Apply at least three evidence-based treatment strategies—including manual therapy techniques, progressive desensitization protocols, and pain neuroscience education— tailored to patient-specific impairments and functional goals.
4. Implement a clinical decision-making framework for sexual pain management in pre- menopausal women that incorporates patient goals, psychosocial factors, and interprofessional collaboration.

About the Speaker

Peng Fan, PT, DPT, is a pelvic health physical therapist and Center Manager at Vibrantcare Rehabilitation in Pinole, California. She specializes in pelvic health, orthopedics, vestibular, and neurological rehabilitation.

Peng Fan graduated from Northwestern University with her Doctor of Physical Therapy degree in April 2023, and obtained her Bachelor's in Applied Exercise Science from Springfield College, MA in 2020. Peng currently serves as Content Editor for the CAPP Pelvic Health Certificate Program and as Content Creator for the CAPP-OB Certificate Program, contributing to advancing pelvic health education nationwide. Currently, she is also serving as the Vice Chair of the Student and Early Career Professionals Community with APTA Orthopedics, and the Newsletter Editor for the International Organization of Physiotherapists in Pelvic and Women'sHealth (IOPPWH).