Background Pelvic floor muscle (PFM) dysfunctions are reported to be involved in provoked vestibulodynia (PVD). Although heightened PFM tone has been suggested, the relative contribution of active and passive components of tone remains misunderstood. Likewise, alterations in PFM contractility have been scarcely studied. Aims To compare PFM tone, including the relative contribution of its active and passive components, and muscular contractility in women with PVD and asymptomatic controls. Methods Fifty-six asymptomatic women and 56 women with PVD participated in the study. The PVD diagnosis was confirmed by a gynecologist based on a standardized examination. Outcomes PFM function was evaluated using a dynamometric speculum combined with surface electromyography (EMG). PFM general tone was evaluated in static conditions at different vaginal apertures and during repeated dynamic cyclic stretching. The active contribution of tone was characterized using the ratio between EMG in a static position and during stretching and the proportion of women presenting PFM activation during stretching. Contribution of the passive component was evaluated using resting forces, stiffness, and hysteresis in women sustaining a negligible EMG signal during stretching. PFM contractility, such as strength, speed of contraction, coordination, and endurance, also was assessed during voluntary isometric efforts. Results Greater PFM resting forces and stiffness were found in women with PVD compared with controls, indicating an increased general tone. An increased active component also was found in women with PVD because they presented a superior EMG ratio, and a larger proportion of them presented PFM activation during stretching. Higher passive properties also were found in women with PVD. Women with PVD also showed decreased strength, speed of contraction, coordination, and endurance compared with controls. Clinical Implications Findings provide further evidence of the contribution of PFM alterations in the etiology of PVD. These alterations should be assessed to provide patient-centered targeted treatment options. Strengths and Limitations The use of a validated tool investigating PFM alterations constitutes a strength of this study. However, the study design does not allow the determination of the sequence of events in which these muscle alterations occurred—before or after the onset of PVD. Conclusion Findings support the involvement of active and passive components of PFM tone and an altered PFM contractility in women with PVD.

This new approach for assessing PFM passive properties showed enough reliability for highly recommending its inclusion in the PFM assessment of SUI postmenopausal women.

The aim of this study was to present a new methodology for evaluating the pelvic floor muscle (PFM) passive properties. The properties were assessed in 13 continent women using an intra-vaginal dynamometric speculum and EMG (to ensure the subjects were relaxed) in four different conditions: (1) forces recorded at minimal aperture (initial passive resistance); (2) passive resistance at maximal aperture; (interquartile range 13.33). This original approach to evaluating the PFM passive properties is very promising for providing better insight into the patho-physiology of stress urinary incontinence and pinpointing conservative treatment mechanisms.

OBJECTIVES: To report on the content development, construct validity, and reliability testing of the Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI). DESIGN: Prospective cohort study. SETTING: Six UI outpatient clinics in Quebec, Canada. PARTICIPANTS: Community-dwelling incontinent men and women aged 65 and older. MEASUREMENTS: Thirty-eight items were generated using a literature search and interdisciplinary panel of experts. Item reduction was achieved through field-testing with 75 older men and women with UI attending an information session. The final 20-item draft, measuring older adults' level of confidence in preventing urine loss, was administered to a new group of consecutive patients 1 week before and at the time of their first visit to the UI clinic to enable evaluation of test-retest reliability. A 3-day voiding diary, quantifying the frequency of UI, and the Incontinence Quality of Life questionnaire were used to test construct validity. RESULTS: One hundred sixteen of 300 eligible patients (39%) participated (mean age AE standard deviation 74 AE 6, range 65-87). The GSE-UI items showed normal distributions and no ceiling effects. Self-efficacy scores ranged from 16 to 193 (mean 104 AE 41, possible range 0-200) and correlated positively with quality of life scores (r 5 0.7, Po.001) and negatively with UI severity (r 5 À 0.4, Po.001). Internal consistency for the GSE-UI was 0.94 (Cronbach alpha). Initial test-retest reliability of the 20 items using intraclass correlations ranged from 0.50 to 0.86. CONCLUSION: The GSE-UI will enable measurement of whether a person's confidence in their ability to prevent urine loss is an important mechanism contributing to improvements in UI. J Am Geriatr Soc 56:542-547, 2008.U rinary incontinence (UI) is common, costly, and bothersome and affects quality of life and function. 1-5 Up to 50% of community-dwelling women and 20% of community-dwelling men aged 65 and older experience UI. 6,7 Despite its high prevalence, many of the mechanisms through which UI occurs and remits in elderly people remain incompletely understood. [8][9][10][11][12][13] Patients who experience marked improvements in UI may show minimal or immeasurable changes in urodynamic parameters. 9,10 Among the potentially important but understudied factors that influence UI are psychological factors. A better understanding of the various physical, behavioral, and psychological factors that underlie UI could lead to the development of moreeffective treatment strategies.Evidence suggests that psychological factors play an important role in UI. For instance, placebo treatment of UI in randomized, controlled pharmaceutical trials has yielded reductions in incontinence episodes ranging from 32% to 65%. 14 This so-called placebo effect could have a strong behavioral component as patients become aware of their voiding habits and risk factors for UI, although psychological factors, such as greater self-efficacy for retaining urine, could also explain it. Self-efficacy derives from social-learning t...