Physiotherapy in Treating Sexual Pain Disorders in Women: A Systematic Review

Abstract

Importance: A lot of women suffer from sexual disfunctions, which most of the times cause pain and discomfort. Many genito-pelvic pain disorders appear in the form of contractions or pelvic floor muscle tension, which makes any type of penetration (sexual, tampons, gynaecological examination tools) impossible. In this condition, a woman cannot control these muscle contractions and experiences moderate to intense pain. Objectives: To summarise published evidence on efficacy of physiotherapy for treating female sexual pain disorders, ways to evaluate the condition of a patient and to find the correct treatment. Evidence review: A literature search of Cochrane, PubMed, Journal of Sexual Medicine and Urogynecology Journal databases, SciELO, Google Scholar, Wiley Online Library and University of Barcelona Library was conducted. Findings: Physiotherapy techniques are used to strengthen pelvic floor muscles and relieve pain. Kegel exercises improve the symptoms of sexual pain disorders as they deal with weakened muscles. Vaginal cones exercises are used to strengthen the muscles by means of introduction of gradually increasing weights in the vagina. Biofeedback helps to increase muscle awareness and auto-evaluation of performed exercises. Thermotherapy relaxes muscles and increases elasticity of tissues which helps to reduce pain. Electro-stimulation improves the functionality of muscles. Myofascial therapy consists mainly in manual therapy and in liberating painful trigger points. Conclusions: The role of pelvic physiotherapy is to solve the problems related to sexual pain, recovering the pelvic floor by increasing muscle awareness and proprioception, improving muscle relaxation, toning the muscles and increasing the elasticity of the tissues in order to eliminate or reduce pain. Different exercise techniques, biofeedback, manual therapy and insertion techniques, as well as electro-stimulation and thermotherapy are used to achieve positive results.

Abordagem terapêutica em mulheres com Vaginismo: revisão de literatura / Therapeutic approach in women with Vaginism: literature review

“…Os exercícios de Kegel são exercícios terapêuticos utilizados para o fortalecimento dos MAP, coordenação corporal e muscular, proporcionando assim, além do fortalecimento, o relaxamento muscular. São caracterizados por ciclos repetitivos de contrações e relaxamento dos MAP, aumentando a força da musculatura perineal (ROCHERA, 2016). Essas contrações podem ser fracionadas, sustentadas ou rápidas, devendo ser utilizado o máximo de força (LATORRE, 2010 apud NEGAMINE; DANTAS; SILVA, 2021).…”

“…Pesos em forma de cones são inseridos transvaginalmente e utilizados durante os exercícios. Cada cone possui um peso diferente, que segundo Nagamine, Dantas e Silva (2021), variam de 20 a 120g e devem ser mantidos dentro da vagina durante alguns minutos, enquanto a mulher permanece em pé ou caminhando.…”

Ultrasonography Comparison of Pelvic Floor and Abdominal Wall Muscles in Women with and without Dyspareunia: A Cross-Sectional Study

“…However, some authors report hypertonia and higher reflex responses in superficial pelvic floor muscles in women with DP. Deep muscle involvement still remains unclear [ 22 , 23 , 24 ]. Several studies conducted in gynecological cancer survivors and patients with endometriosis showed differences in pelvic floor architecture related with DP [ 9 , 24 , 25 , 26 ].…”