Continuing Medical Education: The Role of Pelvic Floor Physical Therapy in the Treatment of Pelvic and Genital Pain-Related Sexual Dysfunction (CME)

Abstract

Introduction Chronic pelvic pain (CPP) in women and men is associated with significant sexual dysfunction. Recently, musculoskeletal factors have been recognized as significant contributors to the mechanism of pelvic pain and associated sexual dysfunction, and in particular, pelvic floor muscle hypertonus has been implicated. Aim The purpose of this Continuing Medical Education article is to describe the musculoskeletal components involved in pelvic and genital pain syndromes and associated sexual dysfunction, introduce specific physical therapy assessment and intervention techniques, and provide suggestions for facilitating an effective working relationship among practitioners involved in treating these conditions. Methods A review of the relevant literature was performed, clarifying current definitions of pelvic pain, elucidating the role of musculoskeletal factors, and determining the efficacy of physical therapy interventions. Results A review of the role of physical therapy for the treatment of pelvic pain and related sexual dysfunction. Conclusions Physical therapy treatment of pelvic pain is an integral component of the multidisciplinary approach to CPP and associated sexual dysfunction.

Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

“…Relaxation is assessed after attempted voluntary contraction. 28,31 A rectal examination is important, not only to assess the anal sphincter but also to evaluate the coccygeus, levator ani muscles, sacrococcygeal ligaments, and attachments to the sacrum and coccyx. A careful clinical examination is very useful and sometimes sufficient for identifying nonrelaxing pelvic floor dysfunction.…”

“…Manual techniques may include trigger point massage, myofascial release, straincounterstrain, and joint mobilization, among others. 31,37 In addition, exercises to strengthen and stabilize the core muscles usually are included with pelvic floor physical therapy. A resource to help clinicians identify physical therapists who specialize in pelvic floor dysfunction may be found at the American Physical Therapy Association's Web site (www.womenshealthapta.…”

Physical Therapy for Female Pelvic Pain

“…An additional study by Tu et al [ 17 ] . and reports by Rosenbaum and Owens [ 24 ] and Prendergast and Weiss [ 48 ] discuss several musculoskeletal parameters that are commonly evaluated by physical therapists including posture, pelvic stability, hip range of motion, fl exibility and tenderness in pelvic girdle muscles, and pelvic fl oor examination. While there are descriptive differences among these authors, what remains consistent is the high incidence of MSk dysfunction identi fi ed by each with regard to pelvic pain populations.…”

“…This can lead to ischemic pain with trigger points and decreased functional range of motion (ROM). This continuous muscle tension leads to further functional impairments relative to pain, continence, respiration, pelvic stability, and sexual function [ 16,17,21,24,25 ] .…”

Multidisciplinary Management of Sexual Dysfunction, Perineal Pain, and Elimination Dysfunction in a Woman with Multiple Sclerosis

“…Physical therapy, following an evidence-based approach, [10][11][12][13] was characterized by pelvic floor muscle training, perineal massage, to primary, secondary, and tertiary consequences of the disease. Primary consequences refer to the direct result of MS-related neurologic changes on sexual function, such as impaired genital sensation, decreased sexual desire, decreased vaginal lubrication, and orgasmic dysfunction.…”