Ultrasonography Comparison of Pelvic Floor and Abdominal Wall Muscles in Women with and without Dyspareunia: A Cross-Sectional Study

Elena Castellanos-López, Camila Castillo-Merino, Vanesa Abuín-Porras, Daniel López-López, Carlos Romero-Morales, Elena Castellanos-López, Camila Castillo-Merino, Vanesa Abuín-Porras, Daniel López-López, Carlos Romero-Morales

Abstract

Pelvic floor hypertonicity and narrowing of the levator ani hiatus is traditionally assumed in women with dyspareunia and considered a therapeutical target by physical therapists. However, accurate pre-treatment assessment of pelvic floor muscles is difficult to perform in clinical sites. In addition, the abdominal musculature has not been evaluated in this population, despite its relationship with pelvic floor disfunctions. The purpose of this study was to determine the existence of differences in the length of the anteroposterior diameter of the levator ani hiatus (APDH), the thickness of the abdominal wall musculature and the interrecti distance (IRD) in subjects with dyspareunia compared to a control group. A cross-sectional observational study was designed using ultrasound imaging to measure the APH, the thickness of the abdominal musculature—rectus abdominis (RA), transverse abdominis (TrAb), internal oblique (IO), external oblique (EO)—and IRD at rest and during contraction. Thirty-two women were recruited through advertising and social webs and divided into two groups: dyspareunia (n = 16) and no dyspareunia (n = 16). There were no statistically significant differences (p < 0.05) in RA, TrAb, OI and OE muscle thickness. No differences in APH or in supraumbilical and infraumbilical IRD were found. The findings of this study suggest that the relationship between the abdominal structure/levator ani hypertonia and dyspareunia remains uncertain.

Keywords: abdominal muscles; dyspareunia; pelvic floor; physiotherapy; ultrasound.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
IRD assessment procedure. (A,B) Probe positioning. (C) Ultrasound image Source: Elena Castellanos López (AKA Soike).
Figure 3
Figure 3
(A) Probe positioning, (B) pelvic floor (PF) muscle imaging. Source: Elena Castellanos López (AKA Soike).

References

    1. Wallace S.L., Miller L.D., Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr. Opin. Obstet. Gynecol. 2019;31:485–493. doi: 10.1097/GCO.0000000000000584.
    1. Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: An untapped resource. Int. Urogynecol. J. 2018;29:631–638. doi: 10.1007/s00192-017-3536-8.
    1. Alimi Y., Iwanaga J., Oskouian R.J., Loukas M., Tubbs R.S. The clinical anatomy of dyspareunia: A review. Clin. Anat. 2018;31:1013–1017. doi: 10.1002/ca.23250.
    1. Laumann E.O., Paik A., Rosen R.C. Sexual Dysfunction in the United StatesPrevalence and Predictors. JAMA. 1999;281:537–544. doi: 10.1001/jama.281.6.537.
    1. Ghaderi F., Bastani P., Hajebrahimi S., Jafarabadi M.A., Berghmans B. Pelvic floor rehabilitation in the treatment of women with dyspareunia: A randomized controlled clinical trial. Int. Urogynecol. J. 2019;30:1849–1855. doi: 10.1007/s00192-019-04019-3.
    1. Morin M., Binik Y.M., Bourbonnais D., Khalifé S., Ouellet S., Bergeron S. Heightened Pelvic Floor Muscle Tone and Altered Contractility in Women with Provoked Vestibulodynia. J. Sex. Med. 2017;14:592–600. doi: 10.1016/j.jsxm.2017.02.012.
    1. Whittaker J.L. Ultrasound imaging of the lateral abdominal wall muscles in individuals with lumbopelvic pain and signs of concurrent hypocapnia. Man. Ther. 2008;13:404–410. doi: 10.1016/j.math.2007.03.008.
    1. Whittaker J.L., Warner M.B., Stokes M. Comparison of the sonographic features of the abdominal wall muscles and connective tissues in individuals with and without lumbopelvic pain. J. Orthop. Sports Phys. Ther. 2013;43:11–19. doi: 10.2519/jospt.2013.4450.
    1. Mabrouk M., Del Forno S., Spezzano A., Raimondo D., Arena A., Zanello M., Leonardi D., Paradisi R., Seracchioli R. Painful Love: Superficial Dyspareunia and Three Dimensional Transperineal Ultrasound Evaluation of Pelvic Floor Muscle in Women with Endometriosis. J. Sex Marital Ther. 2020;46:187–196. doi: 10.1080/0092623X.2019.1676852.
    1. Morin M., Bergeron S., Khalifé S., Mayrand M.-H., Binik Y.M. Morphometry of the pelvic floor muscles in women with and without provoked vestibulodynia using 4D ultrasound. J. Sex. Med. 2014;11:776–785. doi: 10.1111/jsm.12367.
    1. Delancey J.O., Hurd W.W. Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse. Obstet. Gynecol. 1998;91:364–368. doi: 10.1016/S0029-7844(97)00682-0.
    1. Dietz H.P., Shek C., Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet. Gynecol. Off. J. Int. Soc. Ultrasound Obstet. Gynecol. 2005;25:580–585. doi: 10.1002/uog.1899.
    1. Dietz H.P., Shek C., De Leon J., Steensma A.B. Ballooning of the levator hiatus. Ultrasound Obstet. Gynecol. Off. J. Int. Soc. Ultrasound Obstet. Gynecol. 2008;31:676–680. doi: 10.1002/uog.5355.
    1. Roos A.-M., Speksnijder L., Steensma A.B. Postpartum sexual function; the importance of the levator ani muscle. Int. Urogynecol. J. 2020;31:2261–2267. doi: 10.1007/s00192-020-04250-3.
    1. Hsu S.L., Oda H., Shirahata S., Watanabe M., Sasaki M. Effects of neuromuscular training on core stability. J. Phys. Ther. Sci. 2018;30:1014–1018. doi: 10.1589/jpts.30.1014.
    1. Abuín-Porras V., Maldonado-Tello P., de la Cueva-Reguera M., Rodríguez-Sanz D., Calvo-Lobo C., López-López D., Navarro-Flores E., Romero-Morales C. Comparison of Lateral Abdominal Musculature Activation during Expiration with an Expiratory Flow Control Device Versus the Abdominal Drawing-in Maneuver in Healthy Women: A Cross-Sectional Observational Pilot Study. Medicina. 2020;56:84. doi: 10.3390/medicina56020084.
    1. Sapsford R.R., Hodges P.W., Richardson C.A., Cooper D.H., Markwell S.J., Jull G.A. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol. Urodyn. 2001;20:31–42. doi: 10.1002/1520-6777(2001)20:1<31::AID-NAU5>;2-P.
    1. Junginger B., Baessler K., Sapsford R., Hodges P.W. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int. Urogynecol. J. 2010;21:69–77. doi: 10.1007/s00192-009-0981-z.
    1. Benjamin D.R., Frawley H.C., Shields N., van de Water A.T.M., Taylor N.F. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: A systematic review. Physiotherapy. 2019;105:24–34. doi: 10.1016/j.physio.2018.07.002.
    1. Payne L.A., Seidman L.C., Sim M.S., Rapkin A.J., Naliboff B.D., Zeltzer L.K. Experimental evaluation of central pain processes in young women with primary dysmenorrhea. Pain. 2019;160:1421–1430. doi: 10.1097/j.pain.0000000000001516.
    1. Romero-Morales C., de la Cueva-Reguera M., Miñambres-Vallejo B., Ruiz-Ruiz B., Calvo-Lobo C., Casado-Hernández I., López-López D., Abuín-Porras V. Ultrasound Assessment of the Abdominal Wall Muscles in Women with and without Primary Dysmenorrhea: A Cross-Sectional Study. Diagnostics. 2020;10:166. doi: 10.3390/diagnostics10030166.
    1. Rochera M.B. Physiotherapy in Treating Sexual Pain Disorders in Women: A Systematic Review. Adv. Sex. Med. 2016;6:68337. doi: 10.4236/asm.2016.63004.
    1. Li-Yun-Fong R.J., Larouche M., Hyakutake M., Koenig N., Lovatt C., Geoffrion R., Brotto L.A., Lee T., Cundiff G.W. Is Pelvic Floor Dysfunction an Independent Threat to Sexual Function? A Cross-Sectional Study in Women with Pelvic Floor Dysfunction. J. Sex. Med. 2017;14:226–237. doi: 10.1016/j.jsxm.2016.11.323.
    1. Cyr M.-P., Dumoulin C., Bessette P., Pina A., Gotlieb W.H., Lapointe-Milot K., Morin M. Characterizing Pelvic Floor Muscle Function and Morphometry in Survivors of Gynecological Cancer Who Have Dyspareunia: A Comparative Cross-Sectional Study. Phys. Ther. 2021;101:pzab042. doi: 10.1093/ptj/pzab042.
    1. Huffman L.B., Hartenbach E.M., Carter J., Rash J.K., Kushner D.M. Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecol. Oncol. 2016;140:359–368. doi: 10.1016/j.ygyno.2015.11.010.
    1. Del Forno S., Arena A., Pellizzone V., Lenzi J., Raimondo D., Cocchi L., Paradisi R., Youssef A., Casadio P., Seracchioli R. Assessment of levator hiatal area using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: Randomized controlled trial. Ultrasound Obstet. Gynecol. Off. J. Int. Soc. Ultrasound Obstet. Gynecol. 2021;57:726–732. doi: 10.1002/uog.23590.
    1. Falkert A., Willmann A., Endress E., Meint P., Seelbach-Göbel B. Three-dimensional ultrasound of pelvic floor: Is there a correlation with delivery mode and persisting pelvic floor disorders 18-24 months after first delivery? Ultrasound Obstet. Gynecol. Off. J. Int. Soc. Ultrasound Obstet. Gynecol. 2013;41:204–209. doi: 10.1002/uog.11214.
    1. von Elm E., Altman D.G., Egger M., Pocock S.J., Gøtzsche P.C., Vandenbroucke J.P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. J. Clin. Epidemiol. 2008;61:344–349. doi: 10.1016/j.jclinepi.2007.11.008.
    1. Stetts D.M., Freund J.E., Allison S.C., Carpenter G. A rehabilitative ultrasound imaging investigation of lateral abdominal muscle thickness in healthy aging adults. J. Geriatr. Phys. Ther. 2009;32:60–66. doi: 10.1519/00139143-200932020-00004.
    1. van Veelen G.A., Schweitzer K.J., van der Vaart C.H. Ultrasound imaging of the pelvic floor: Changes in anatomy during and after first pregnancy. Ultrasound Obstet. Gynecol. Off. J. Int. Soc. Ultrasound Obstet. Gynecol. 2014;44:476–480. doi: 10.1002/uog.13301.
    1. Hides J.A., Miokovic T., Belavý D.L., Stanton W.R., Richardson C.A. Ultrasound Imaging Assessment of Abdominal Muscle Function During Drawing-in of the Abdominal Wall: An Intrarater Reliability Study. J. Orthop. Sport. Phys. Ther. 2007;37:480–486. doi: 10.2519/jospt.2007.2416.
    1. Finucane L.M., Downie A., Mercer C., Greenhalgh S.M., Boissonnault W.G., Pool-Goudzwaard A.L., Beneciuk J.M., Leech R.L., Selfe J. International Framework for Red Flags for Potential Serious Spinal Pathologies. J. Orthop. Sports Phys. Ther. 2020;50:350–372. doi: 10.2519/jospt.2020.9971.
    1. Maselli F., Palladino M., Barbari V., Storari L., Rossettini G., Testa M. The diagnostic value of Red Flags in thoracolumbar pain: A systematic review. Disabil. Rehabil. 2022;44:1190–1206. doi: 10.1080/09638288.2020.1804626.
    1. Chiarello C.M., McAuley J.A. Concurrent Validity of Calipers and Ultrasound Imaging to Measure Interrecti Distance. J. Orthop. Sport. Phys. Ther. 2013;43:495–503. doi: 10.2519/jospt.2013.4449.
    1. Wen L., Zhou Q. Can We Evaluate Hiatal Ballooning by Measuring the Anteroposterior Diameter with 2-Dimensional Translabial Ultrasonography? J. Ultrasound Med. Off. J. Am. Inst. Ultrasound Med. 2018;37:1001–1006. doi: 10.1002/jum.14445.
    1. Thibault-Gagnon S., McLean L., Goldfinger C., Pukall C., Chamberlain S. Differences in the Biometry of the Levator Hiatus at Rest, During Contraction, and During Valsalva Maneuver Between Women with and without Provoked Vestibulodynia Assessed by Transperineal Ultrasound Imaging. J. Sex. Med. 2016;13:243–252. doi: 10.1016/j.jsxm.2015.12.009.
    1. Vercellini P., Viganò P., Somigliana E., Fedele L. Endometriosis: Pathogenesis and treatment. Nat. Rev. Endocrinol. 2014;10:261–275. doi: 10.1038/nrendo.2013.255.
    1. Greene A.D., Lang S.A., Kendziorski J.A., Sroga-Rios J.M., Herzog T.J., Burns K.A. Endometriosis: Where are we and where are we going? Reproduction. 2016;152:R63–R78. doi: 10.1530/REP-16-0052.
    1. Vercellini P., Buggio L., Frattaruolo M.P., Borghi A., Dridi D., Somigliana E. Medical treatment of endometriosis-related pain. Best Pract. Res. Clin. Obstet. Gynaecol. 2018;51:68–91. doi: 10.1016/j.bpobgyn.2018.01.015.
    1. Yong P.J. Deep Dyspareunia in Endometriosis: A Proposed Framework Based on Pain Mechanisms and Genito-Pelvic Pain Penetration Disorder. Sex. Med. Rev. 2017;5:495–507. doi: 10.1016/j.sxmr.2017.06.005.
    1. Ji R.-R., Nackley A., Huh Y., Terrando N., Maixner W. Neuroinflammation and Central Sensitization in Chronic and Widespread Pain. Anesthesiology. 2018;129:343–366. doi: 10.1097/ALN.0000000000002130.
    1. López-Ruiz M., Losilla J.M., Monfort J., Portell M., Gutiérrez T., Poca V., Garcia-Fructuoso F., Llorente J., Garcia-Fontanals A., Deus J. Central sensitization in knee osteoarthritis and fibromyalgia: Beyond depression and anxiety. PLoS ONE. 2019;14:e0225836. doi: 10.1371/journal.pone.0225836.
    1. van Griensven H., Schmid A., Trendafilova T., Low M. Central Sensitization in Musculoskeletal Pain: Lost in Translation? J. Orthop. Sports Phys. Ther. 2020;50:592–596. doi: 10.2519/jospt.2020.0610.
    1. Hides J., Wilson S., Stanton W., McMahon S., Keto H., McMahon K., Bryant M., Richardson C. An MRI investigation into the function of the transversus abdominis muscle during “drawing-in” of the abdominal wall. Spine. 2006;31:175–178. doi: 10.1097/01.brs.0000202740.86338.df.
    1. Urquhart D.M., Hodges P.W., Allen T.J., Story I.H. Abdominal muscle recruitment during a range of voluntary exercises. Man. Ther. 2005;10:144–153. doi: 10.1016/j.math.2004.08.011.
    1. Dias-Amaral A., Marques-Pinto A. Female Genito-Pelvic Pain/Penetration Disorder: Review of the Related Factors and Overall Approach. Rev. Bras. Ginecol. Obstet. Rev. Fed. Bras. Soc. Ginecol. Obstet. 2018;40:787–793. doi: 10.1055/s-0038-1675805.
    1. Alizadeh A., Farnam F., Raisi F., Parsaeian M. Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women. J. Sex. Med. 2019;16:1068–1077. doi: 10.1016/j.jsxm.2019.04.019.

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