Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial

Fariba Ghaderi, Parvin Bastani, Sakineh Hajebrahimi, Mohammad Asghari Jafarabadi, Bary Berghmans, Fariba Ghaderi, Parvin Bastani, Sakineh Hajebrahimi, Mohammad Asghari Jafarabadi, Bary Berghmans

Abstract

Introduction and hypothesis: Dyspareunia, the symptom of painful sexual intercourse, is a common sexual dysfunction in reproductive-aged women. Because of its multifactorial etiology, a multidisciplinary approach may be required to treat it. Musculoskeletal factors play an important role; thus, rehabilitating the pelvic floor and modifying the tone of the pelvic floor muscles (PFMs) may be an effective way to treat this dysfunction. The aim of this randomized controlled clinical study was to evaluate the effects of pelvic floor rehabilitation techniques on dyspareunia.

Methods: Of 84 women, assessed for eligibility, 64 women with dyspareunia were randomized into two groups: the experimental group (n = 32) received electrotherapy, manual therapy, and PFM exercises and the control group (n = 32) had no treatment while on the waiting list. Evaluations of PFM strength and endurance, sexual function, and pain were made directly before and after 3 months of treatment and at the 3-month follow-up.

Results: Between-group changes showed significant improvement in the experimental group in comparison with control group. Mean difference in the PFM strength (according to the 0-5 Oxford scale) between groups was 2.01 and the mean difference of endurance was 6.26 s. Also, the mean difference in the Female Sexual Function Index score (the score ranges from 2 to 95) was 51.05, and the mean difference in the VAS score was 7.32. All of the changes were statistically significant (p < 0.05).

Conclusions: According to the results, pelvic floor rehabilitation is an important part of a multidisciplinary treatment approach to dyspareunia.

Keywords: Dyspareunia; Pelvic floor rehabilitation; Sexual dysfunction.

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
CONSORT 2010 flow diagram of the study
Fig. 2
Fig. 2
The trend of visual analog scale (VAS) changes before/after and follow-up measurements in both groups

References

    1. Rogers RG, Pauls RN, Thakar R, Morin M, Kuhn A, Petri E, Fatton B, Whitmore K, Kingsberg SA, Lee J. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Int Urogynecol J. 2018;29(5):647–666. doi: 10.1007/s00192-018-3603-9.
    1. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281:537–544. doi: 10.1001/jama.281.6.537.
    1. Sobhgol SS, Mohammad Alizadeh Charndabee S. Rate and related factors of dyspareunia in reproductive age women: a cross-sectional study. Int J Impot Res. 2007;19:88–94. doi: 10.1038/sj.ijir.3901495.
    1. Polland AR, Davis M, Zeymo A, Iglesia CB. Association between comorbidities and female sexual dysfunction: findings from the third National Survey of sexual attitudes and lifestyles (Natsal-3) Int Urogynecol J. 2019;30(3):377–383. doi: 10.1007/s00192-018-3739-7.
    1. Latthe P, Mignini L, Gray R. Factors predisposing women to chronic pelvic pain: systematic review. BMJ. 2006;332:749–755. doi: 10.1136/bmj.38748.697465.55.
    1. Goldfinger C, Pukall CF, Gentilcore-Saulnier E, McLean L, Chamberlain S. A prospective study of pelvic floor physical therapy: pain and psychosexual outcomes in provoked vestibulodynia. J Sex Med. 2009;6(7):1955–1968. doi: 10.1111/j.1743-6109.2009.01304.x.
    1. Piassarolli VP, Hardy E, Andrade NF, Ferreira NO, Osis MJD. Pelvic floor muscle training in female sexual dysfunctions. Rev Bras Gynecol Obstet. 2010;32(5):234–240.
    1. Bø K, Berghmams B, Mørkved S, Van Kampen M. Evidence-based physical therapy for the pelvic floor: bridging science and clinical practice. 2. Amsterdam: Elsevier; 2014.
    1. Rosenbaum TY, Owens A. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. J Sex Med. 2008;5:513–523. doi: 10.1111/j.1743-6109.2007.00761.x.
    1. Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J. 2018;29(5):631–638. doi: 10.1007/s00192-017-3536-8.
    1. Montenegro MLLS, Vasconcelos ECLM, Candido dos Reis FJ, Nogueira AA. Physical therapy in the management of women with chronic pelvic pain. Int J Clin Pract. 2008;62(2):263–269. doi: 10.1111/j.1742-1241.2007.01530.x.
    1. Bergeron S, Binik YM, Khalife S, Pagidas K, Glazer HI, Meana M. A randomized comparison of group cognitive behavioural therapy , surface electromyographic biofeedback and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain. 2001;91:297–306. doi: 10.1016/S0304-3959(00)00449-8.
    1. Rivalta M, Sighinolfi MC, Micali S, De Stefani S. Sexual function and quality of life in women with urinary incontinence treated by a complete pelvic floor rehabilitation program (biofeedback, functional electrical stimulation, pelvic floor muscles exercises, and vaginal cones) J Sex Med. 2010;7:1200–1208. doi: 10.1111/j.1743-6109.2009.01676.x.
    1. Bo K, Kvarstein B, Hagen R, Larsen S. Pelvic floor muscle exercises for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction. Neurourol Urodyn. 1990;9:479–487. doi: 10.1002/nau.1930090504.
    1. Fisher KA. Management of dyspareunia and associated levator ani muscle over activity. Phys Ther. 2007;87:935–941. doi: 10.2522/ptj.20060168.
    1. Ensor AW, Newton RA. The role of biofeedback and soft tissue mobilization in the treatment of dyspareunia: a systematic review. J Womens Health Phys Ther. 2014;38(2):74–80. doi: 10.1097/JWH.0000000000000011.
    1. Morin M, Carroll MS, Bergeron S. Systematic review of the effectiveness of physical therapy modalities in women with provoked vestibulodynia. Sex Med Rev. 2017;5(3):295–322. doi: 10.1016/j.sxmr.2017.02.003.
    1. Asghari-Jafarabadi M, Sadeghi-Bazargani H. Randomization: techniques and software aided implementation in medical studies. J Clin Res Gov. 2015;4(2):1–6.
    1. Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract. 2003;3(4):310–316. doi: 10.1111/j.1530-7085.2003.03034.x.
    1. Fakhri A, Pakpour AH, Burri A, Morshedi H, Zeidi IM. The female sexual function index: translation and validation of an Iranian version. J Sex Med. 2012;9(2):514–523. doi: 10.1111/j.1743-6109.2011.02553.x.
    1. Murina F, Bernorio R, Palmiotto R. The use of Amielle vaginal trainers as adjuvant in the treatment of vestibulodynia: an observational multicentric study. Medscape J Med. 2008;10(1):23.
    1. Danielsson I, Torstensson T, Brodda-Jansen G, Bohm-Starke N. EMG biofeedback versus topical lidocaine gel: a randomized study for the treatment of women with vulvar vestibulitis. Acta Obstet Gynecol Scand. 2006;85(11):1360–1367. doi: 10.1080/00016340600883401.
    1. Holland A. Physical therapy intervention for dyspareunia: a case report. J Sect Womens Health. 2003;27(1):18–20.
    1. Schvartzman R, Schvartzman L, Ferreira CF, Vettorazzi J, Bertotto A, Wender MCO. Physical therapy intervention for women with dyspareunia: a randomized clinical trial. J Sex Marital Ther. 2019;14:1–17.
    1. Shigeta M, Sekiguchi Y, Nakamura R. Effects of physical therapy on female dyspareunia in Japan. J Sex Med. 2016;13(6):S255. doi: 10.1016/j.jsxm.2016.04.036.
    1. Prendergast SA. Pelvic floor physical therapy for vulvodynia: a clinician’s guide. Obstet Gynecol Clin. 2017;44(3):509–522. doi: 10.1016/j.ogc.2017.05.006.
    1. Denneny D, Frawley HC, Petersen K, McLoughin R, Brook S, Hassan S, Williams AC. Trigger point manual therapy for the treatment of chronic noncancer pain in adults: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100:562–577. doi: 10.1016/j.apmr.2018.06.019.
    1. Felicíssimo MF, Carneiro MM, Saleme CS, Pinto RZ, da Fonseca AM, da Silva-Filho AL. Intensive supervised versus unsupervised pelvic floor muscle training for the treatment of stress urinary incontinence: a randomized comparative trial. Int Urogynecol J. 2010;21(7):835–840. doi: 10.1007/s00192-010-1125-1.
    1. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10:CD005654.
    1. Naess I, Bø K. Can maximal voluntary pelvic floor muscle contraction reduce vaginal resting pressure and resting EMG activity? Int Urogynecol J. 2018;29(11):1623–1627. doi: 10.1007/s00192-018-3599-1.
    1. Kaplan B, Rabinerson D, Pardo J, Krieser RU, Neri A. Transcutaneous electrical nerve stimulation (TENS) as a pain-relief device in obstetrics and gynaecology. Clin Exp Obstet Gynecol. 1997;24(3):123–126.
    1. Sobhgol SS, Priddis H, Smith CA, Dahlen HG. The effect of pelvic floor muscle exercise on female sexual function during pregnancy and postpartum: a systematic review. Sex Med Rev. 2019;7(1):13–28. doi: 10.1016/j.sxmr.2018.08.002.
    1. Manresa M, Pereda A, Bataller E, Terre-Rull C, Ismail KM, Webb SS. Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis. Int Urogynecol J. 2019;30(6):853–868. doi: 10.1007/s00192-019-03894-0.

Source: PubMed

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