(057) Effectiveness of a Suggested Protocol to Treat Increased Pelvic Floor Muscle Tone in Women with Dyspareunia: A Retrospective Cohort Study
Authors: Maeda T , Parizotto F , Araújo C , Juliato C , Bardin M 
Published: May 2023

Abstract

Introduction
Pelvic floor muscle (PFM) increased tone is known to play a key role in the physiopathology of different conditions presenting dyspareunia, namely vaginismus, vulvodynia, vulvar lichen sclerosus and atrophicus and genitourinary syndrome of menopause. Although physical therapy is considered first line treatment of PFM increased tone, no protocol thus far has been fully presented on how to manage manual therapy and vaginal dilators to treating this population.

Objective
To assess the effectiveness of a treatment protocol for women with dyspareunia.

Methods
Medical charts of women diagnosed with vaginismus, vulvodynia, vulvar lichen sclerosus and atrophicus and genitourinary syndrome of menopause treated at the Physical Therapy with the local service`s muscle tone normalization protocol from January 2017 till July 2021 and who had increased PFM tone were included in this retrospective, cohort study. Exclusion criteria: suspected vulvovaginal infection during physical therapy treatment; treatments that did not stricted follow the suggested protocol for dyspareunia treatment; lesion in the vaginal introitus and missing data. Women were assessed at baseline and post-treatment for (i.) PFM tone via digital palpation according to Reissing scale consisting of a 7-level grading score from -3 (most decreased) to +3 (most increased PFM tone); (ii.) self-report of penetration disorder and/or deep dyspareunia as yes or no; (iii.) pain intensity during vaginal penetrative intercourse according to numerical rate scale (NRS) from 0 (no pain) to 10 (worst possible pain); (iv.) self-reported sexual arousal as low, medium or high and (v.) number and NRS pain intensity for each PFM active trigger point assessed through digital palpation. Women attended to 12 physical therapy sessions, for 6 weeks, including manual therapy (myofascial release, manual stretching of the vaginal walls and perineal massage); testing and graduation of vaginal dilators to be used daily at home right after self vaginal-stretching (see Figure 1).

Results
In total, 48 women were included in this study. Most were married (65%) and mean age was 46 years old (±7). Diagnosis were: vaginismus (n=11), vulvodynia (n=15), vulvar lichen sclerosus and atrophicus (n=7), genitourinary syndrome of menopause (n=9) and non-specific dyspareunia. Adhesion to treatment was of 88% regarding presence sessions, and all women reported from moderate to great adhesion to home exercises. Most of women (43%) could start the use of dilators with the number 3 of a 6-progressive-units kit and finished the treatment using the 6th (82%), p=&lt;0.001; d=1.24. All those who did not succeed to the final dilator, were able to achieve the 5th one. Compared from baseline to post-treatment, statistical significant changes were found for changes in the PFM tone (-3 to 3, Reissing scale) (2.6 (±1.0) vs. 0.7 (±1.1); p=0.04; d=1.14); self-report of penetration disorder from 92% to 12%, p&lt;0.001; pain intensity of trigger points 4.97 (±3.35) vs. 1.59 (±2.54); &lt;0.001; d=1.38) and for intensity during vaginal penetrative intercourse according to NRS (6.73 (±3.54) vs. 1.92 (±2.9); p &lt;0.001, d=1.18). No differences for self-reported sexual arousal and number of trigger points were shown.

Conclusions
Women undergoing the presented physical therapy protocol showed improvement in dyspareunia related-symptoms.

Disclosure
No