Relationship Among Vaginal Palpation, Vaginal Squeeze Pressure and Dynamometry of Nulliparous Pelvic Floor Muscles
Condition: Correlation of Pelvic Floor Muscle Evaluation Methods
Study type: Observational [Patient Registry]

Summary: 
      The aim of this study is to determine if there is a correlation between digital palpation,
      perineometry and dynamometry as PFM function evaluation methods in nulliparous without pelvic
      floor dysfunction.
    

Detailed description: 
      Study design - this study was conducted in Cinesiofunctional Performance Laboratory Pelvic
      and Women's Health at the Federal University of Uberlandia (UFU), the volunteers were
      recruited from December 2014 to July 2015. This is an observational, cross-sectional and
      comparative study, the sample consisted of 141 nulliparous women (non-pregnant nulliparous or
      primigravids). All volunteer shave signed an informed consent and the study was approved by
      the Ethics Committee of the Federal University of Uberlandia (No.1067162/2014). Female
      students of UFU were invited by personal contact to participate in the study. The
      primigravids were participants in the Prenatal Program of the public health system in
      Uberlandia city and they have also been invited by personal contact. Inclusion criterion for
      volunteers were: never have passed for childbirth situation,ability to contract correctly the
      PFM and without urogynecological complaints. Exclusion criterion were: history of previous
      pelvic surgery, without previous sexual intercourse, and present neuromuscular diseases. The
      experient examiner, with expertise in PFM evaluation conducted the evaluations. After
      checking that they were eligible to participate in the survey, participants were asked to
      empty the bladder and to remain in the supine position on an appropriate bed with hips and
      knees flexed and maintaining the lumbar spine in neutral position.The PFM assessment was
      performed by vaginal palpation, vaginal squeeze pressure and dynamometry. The vaginal
      palpation and vaginal squeeze pressure are widely used in research involving the female
      pelvic floor and many studies have shown its reproducibility and validity(10, 11, 12, 13).
      The measurements performed with a dynamometer in this study were similar to the study of
      Martinho et al(4) which used the same instrument and have demonstrated reproducibility of the
      assessment method. During all PFM assessments, the volunteer was advised to stay relaxed and
      breathing normally. To be considered valid, the cranial elevation movement was observed by
      the examiner, as well as the absence of visible contractions of the adductor, muscles of the
      hip, gluteal muscles or abdominals. Strong verbal command was adopted to request the PFM
      contraction in all exams.

      Assessments began after explaining how to perform the PFM contraction. The vaginal palpation
      was always the first exam to check the PFM contraction ability and then the order of vaginal
      squeeze pressure exam and dynamometry was randomized.

      The PFM assessment by digital palpation was performed as proposed by Laycock and Jerwood. The
      physiotherapist introduced the index and middle fingers about 4 cm inside the vagina, and
      requested to hold the maximum contraction of the PFM, according to the instruction of a
      movement "inward and up" with the greatest possible strength. Muscle function was classified
      by the Oxford Scale Modified, which varies from zero (absence of muscle contraction) to five
      (strong contraction). The vaginal squeeze pressure was measured through Peritron equipment
      (Cardio Design Pty Ltd, Oakleigh, Victoria, Australia) equipped with a vaginal probe that has
      been covered with a non-lubricated condom and then the probe was lubricated with
      hypoallergenic gel. The probe sensor was connected to a microprocessor hand with a latex
      tube, which allows the measurement of nip pressure in centimeters of water (cmH2O). To obtain
      the measurements, the subjects remained positioning and vaginal sensor was introduced
      approximately 3.5cm into the vaginal cavity. Then the device was inflated to 100cmH2O
      (calibration). The female volunteers were oriented and motivated verbally to perform three
      voluntary maximal contractions sustained for five seconds and one minute interval between
      them. The correct contraction was checked visually by the physiotherapist. All volunteers
      were instructed to avoid using the abdominal muscles, gluteal and hip adductor. For
      statistical analysis, the investigator used the peak pressure provided by the equipment. The
      PFM contraction strength was assessed by vaginal dynamometer EMG System do Brasil (model DFV
      020.101/10). It is cylindrical in shape (9.5 cm in length and 3.3 cm in diameter), made of
      steel and is equipped with a load cell 2 cm from its base, which can measure anteroposterior
      unidirectional compressive strength in Kg/force (Kgf). The equipment was previously coated
      with a condom and lubricated with hypoallergenic gel, which was inserted into the vaginal
      cavity with the load cell positioned so that it could capture the anteroposterior compression
      strength. The participant was asked to perform three maximal voluntary PFM contractions for
      eight seconds with a rest period of 30 seconds between the contractions. The same precautions
      for correct contraction were adopted. The best value of maximum strength (difference between
      the highest and lowest strength in Kgf) was used for statistical analysis. Statistical
      analysis was performed using Statistical Package for Social Sciences software (SPSSV17,
      Chicago, IL). Data normality was tested by the Shapiro-Wilk test.

      To verify the correlation between the variables, the Pearson correlation test was used.
      Values of p < 0.05 were considered significant. The correlation values were interpreted
      according to the following guidelines: 0.00 - 0.19= no to slight; 0.20-0.39= mild; 0.40-0.69=
      moderate; 0.70-0.89= high and 0.90-1.00= very high. Data were expressed as mean and standard
      deviation (SD).
    

Intervention name(s): pelvic floor muscle strength evaluation
Intervention type(s): Other
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        healthy women without previous labor and delivery - non-pregnant or in their first
        pregnancy
      
Keywords: pelvic floor muscles; evaluation; dynamometer; perineometer