Pelvic training for dyspareunia

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A pelvic floor muscle-training protocol was effective in improving pain, quality of life, sexual function, and pelvic floor muscle function in climacteric women with dyspareunia, according to a clinical trial.

The Brazilian study in the Journal of Sex & Marital Therapy recruited women between ages 40 and 60 who were sexually active and complained of dyspareunia for at least 6 months. 

The pelvic floor muscle training (PFMT) group of 21 women had five 1-hour sessions of thermotherapy for relaxation of pelvic floor muscles, myofascial release, and pelvic training.  Another 21 women, the lower back (LP) group, also received five 1-hour sessions of therapy, during which heat was applied to the lower back with myofascial release of abdominal diaphragm, piriformis, and iliopsoas muscles, but no pelvic training.

Improvement in PFM function was determined through digital palpation using the New PERFECT Scale, which gauges PFM contractility based on items sequentially graded by an examiner: performance, endurance, repetition, 2-minute rest, number of fast PFM contractions, elevation of the posterior vaginal wall, co-contraction, and synchronous involuntary contractions of the PFM during an exertion like coughing. Based on a 10-point Visual Analogue Scale (VAS), the average pain scores in the PFMT group decreased from 7.77 to 2.25 for sexual intercourse in the previous month, compared to a decrease from 7.62 to only 5.58 in the LB group.

The investigators also evaluated sexual function through the 19-question Female Sexual Function Index (FSFI), for which they found higher scores in the PFMT group for desire (P= 0.017), satisfaction (P= 0.005) and pain ( P= 0.005) domains, as well as in overall score (P< 0.018).

In addition, quality of life improved more in the PFMT group for reduction in menopause and health (P≤ 0.001), sexual response cycle (P= 0.006) and overall scores on the Cervantes Scale (P≤0.001).

The investigators cited several previous studies that indicate physical therapy is a useful component to multidisciplinary management of dyspareunia, restoring PFM function, alleviating pain and preventing physical disability by elevating awareness and muscle proprioception, enhancing muscle relaxation, normalizing resting muscle activity, and bolstering vaginal elasticity. 

However, the authors of the current study noted that until now, PFM training has been evaluated primarily for urinary incontinence, thus the study’s physical therapy technique for dyspareunia among climacteric women represents “a novel contribution to the field.”

For treating sexual pain, the authors recommend research in six areas: the mucous membrane; pelvic floor; experience of pain; sexual and relationship function; psychosocial adjustment; and genital mutilation/sexual abuse. “Simply focusing on one symptom or facet of the experience can lead to improvement in that single area; however, this sole effect may not influence other areas of function that are in need of improvement,’ the authors wrote.

Related: Managing Perineal Lacerations And Pelvic Floor Disorders After Childbirth

Despite the encouraging PFMT results in the current study for dyspareunia, limitations included the small sample size, recruitment via advertisements in local newspapers, and lack of participant blinding. “The respondents were subjected to the different techniques of physical therapy and knew the techniques employed to them as a therapy,” the authors wrote.

The authors also mentioned there is no gold standard to assess PFM. Although electromyography (EMG) is an alternative to digital palpation, “its clinical use and signals interpretation must be made with caution, not using the EMG information as the absolute measure,” they wrote.