Pelvic Floor Muscle Assessment Outcomes in Women With and Without Provoked Vestibulodynia and the Impact of a Physical Therapy Program

Abstract

Introduction Physical therapy (PT) may reduce the pain associated with provoked vestibulodynia (PVD) based on previous findings that pelvic floor muscle dysfunction (PFMD) is associated with PVD symptoms. Aims The goals of this study were: (i) to determine whether women with and without PVD differ on measures of pelvic floor muscle (PFM) behavior; and (ii) to assess the impact of PT treatment for women with PVD on these measures. Methods Eleven women with PVD and 11 control women completed an assessment evaluating PFM behavior using surface electromyography (SEMG) recordings and a digital intravaginal assessment. Women with PVD repeated the assessment after they had undergone eight PT treatment sessions of manual therapy, biofeedback, electrical stimulation, dilator insertions, and home exercises. Main Outcome Measures Superficial and deep PFM SEMG tonic activity and phasic activity in response to a painful pressure stimulus, PFM digital assessment variables (tone, flexibility, relaxation capacity, and strength). Results At pretreatment, women with PVD had higher tonic SEMG activity in their superficial PFMs compared with the control group, whereas no differences were found in the deep PFMs. Both groups demonstrated contractile responses to the painful pressure stimulus that were significantly higher in the superficial as compared with the deep PFMs, with the responses in the PVD group being higher than those in control women. Women with PVD had higher PFM tone, decreased PFM flexibility and lower PFM relaxation capacity compared with control women. Posttreatment improvements included less PFM responsiveness to pain, less PFM tone, improved vaginal flexibility, and improved PFM relaxation capacity, such that women with PVD no longer differed from controls on these measures. Conclusion Women with PVD demonstrated altered PFM behavior when compared with controls, providing empirical evidence of PFMD, especially at the superficial layer. A PT rehabilitation program specifically targeting PFMD normalized PFM behavior in women with PVD.

Pelvic floor muscle function in women with provoked vestibulodynia and asymptomatic controls

“…This study found no significant differences between women with and women without PVD in VRP, PFM strength or endurance, while the present study found a significant difference in VRP. Elevated VRP might be maintained passively due to inelasticity of vaginal soft tissue [10]. In the study by Polpeta et al [26] the control group had a higher VRP than the PVD group, whereas sEMG resting activity was slightly higher in the vulvodynia group, which is contrary to our findings.…”

“…More specifically vaginal overactivity, lack of pelvic floor muscle strength and "restriction of the vaginal opening" have been hypothesized to be associated with PVD [8;9], but there are few studies assessing these variables in women with PVD compared to controls [10], and the reported findings on overactivity of the PFM are contradictory [9][10][11][12]. The reliability and validity of digital palpation of the PFM has been questioned [13], and vaginal surface EMG (sEMG) recordings may be flawed by cross-talk activity from other muscles.…”

Female Sexual Pain Disorders: a Review of the Literature on Etiology and Treatment

“…A first retrospective study investigating such a program in a sample of 35 women diagnosed with PVD yielded a 52 % success rate with regard to pain reduction and a significant improvement in participants' sexual functioning [107]. Using a prospective methodology, another study in a sample of 11 women diagnosed with PVD, Gentilcore-Saulnier et al [108] demonstrated that a physical therapy program led to the normalization of the pelvic floor. Women also reported a significant reduction in pain during vaginal palpation and significant decreases in pain during intercourse and during a gynecological examination, as well as improved sexual function [109].…”

Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods

“…Proposed biomedical factors include vaginal infections [7], genetic or immune factors [8], hormonal factors [9], or the proliferation of nociceptors and sensitization [10]. Pelvic floor muscle (PFM) dysfunctions may also play an important role [11], [12] and [13]. It has been reported that women with PVD have heightened PFM tone as well as inferior PFM strength, coordination and endurance compared to asymptomatic women [11], [12] and [13].…”

“…Pelvic floor muscle (PFM) dysfunctions may also play an important role [11], [12] and [13]. It has been reported that women with PVD have heightened PFM tone as well as inferior PFM strength, coordination and endurance compared to asymptomatic women [11], [12] and [13]. Targeting these dysfunctions, multimodal physiotherapy treatment includes education, biofeedback, manual and insertion techniques [14].…”