EditorGranuloma annulare (GA) is a common non-infectious granulomatous didease. 1,2 Although no clear aetiology has been established, trauma, insect bite reactions, tuberculin skin testing, sun exposure, PUVA therapy, adverse reaction to drugs and viral infections have been proposed as inciting factors. 1 Its pathogenesis is probably immunologic. Evidence suggest that GA represents a cell-mediated immune response to an unknown antigen, in which granuloma formation by macrophage-histiocytes is mediated by interaction with T-helper lymphocytes. It is a Th1-driven inflammatory reaction, with interferon γ-producing lymphocytes eliciting matrix degradation. [3][4][5][6] Nearly 15% of patients with GA have the generalized subtype characterized by a later age of onset, increased prevalence of the HLA-Bw35 allele, protracted course, with only rare spontaneous resolution, and alterations in the lipid profile in about 45% of patients. 1,2,5 A 52-year-old Caucasian woman was observed for asymptomatic erythematous-violaceous annular plaques, with raised borders, symmetrically distributed over the neck and subsequently over the trunk and limbs, evolving for 6 months (Fig. 1). Besides rosacea, the patient was otherwise healthy. Laboratory findings, including autoimmune and hormonal screening, tumoral markers, viral, Borrelia burgdorferi and Treponema pallidum serologies and Mycobacterium polymerase chain reaction were all negative. Skin lesion biopsy showed a granulomatous dermatitis pattern with necrobiotic areas and lymphocytic infiltrate, supporting the diagnosis of GA (Fig. 2).

The perineum is formed by muscle-aponeurotic elements that are integrated under the control of the nervous system. Their alterations are responsible for urogynecological, coloproctologic and sexual pathologies. In order to obtain a successful treatment, it is obliged not to forget the role that plays the perineum in those pathologies. The treatment of the dysfunction of the pelvic floor groups conservative techniques and procedures like changes in life habits, behavioural therapy, biofeedback, electroestimulation (neuromodulation and peripheral electrical stimulation) and training with muscular exercises of the pelvic floor (perineal rehabilitation). The objective of all of them is to improve or to obtain the urinary continence, the strengthening of its musculature to be able to balance pelvic static, to improve the local vascularization and the anorrectal function besides securing a satisfactory sexuality.

RESUMENTRATAMIENTO DE LA DISFUNCIÓN DEL SUELO PÉLVICO El periné está formado por elementos músculos-aponeuróticos que se integran bajo el control del sistema nervioso. Su alteración es responsable de patologías uroginecológicas, coloproctológicas y sexuales. Para conseguir su tratamiento exitoso es obligado no olvidar el papel que juega el periné en las mismas.El tratamiento de la disfunción del suelo pélvico agrupa una serie de técnicas y procedimientos conservadores como cambios en hábitos de vida, terapia conductual, biofeedback, electroestimulación (neuromodulación y estimulación eléctrica periférica) y entrenamiento con ejercicios musculares del suelo pélvico (rehabilitación perineal).El objetivo de todas ellas es mejorar o conseguir la continencia urinaria, el fortalecimiento de su musculatura para conseguir equilibrar la estática pélvica, mejorar la vascularización local y la función ano-rectal además de conseguir una sexualidad satisfactoria.Palabras clave: Disfunción de suelo pélvico. Continencia urinaria. Rehabilitación perineal. ABSTRACT TREATMENT OF THE DYSFUNCTION OF THE PELVIC FLOORThe perineum is formed by muscle-aponeurotic elements that are integrated under the control of the nervous system. Their alterations are responsible for urogynecological, coloproctologic and sexual pathologies. In order to obtain a successful treatment, it is obliged not to forget the role that plays the perineum in those pathologies.The treatment of the dysfunction of the pelvic floor groups conservative techniques and procedures like changes in life habits, behavioural therapy, biofeedback, electroestimulation (neuromodulation and peripheral electrical stimulation) and training with muscular exercises of the pelvic floor (perineal rehabilitation).The objective of all of them is to improve or to obtain the urinary continence, the strengthening of its musculature to be able to balance pelvic static, to improve the local vascularization and the anorrectal function besides securing a satisfactory sexuality. E l suelo pélvico o periné es un conjunto de músculos que sustentan la porción abdominal inferior y sirven de apoyo a la vejiga, el útero y una porción del intestino. Es fundamental que esta musculatura mantenga una buena función, ya que la debilidad del suelo pélvico es causa de incontinencia urinaria de esfuerzo, cisto y rectocele, prolapsos genitales, disfunciones sexuales (dispareunia, disminución de la sensibilidad e intensidad del orgasmo).La lesión o debilidad de la musculatura perineal puede estar ocasionada por diversas causas:

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