Physical therapy in sexually dysfunctional women: a systematic review

Abstract

The World Health Organization (WHO) considers Female Sexual Dysfunctions (FSDs) to be a public health issue. There are a multitude of disorders such as female sexual arousal disorder, hypoactive sexual desire disorder, orgasmic disorder, dyspareunia, and vaginismus. FSDs are detected in 67.9% of the women in the world and are present in 50% of Asians, in 30-50% of Americans, and in 30% of Brazilians. Objective: To systematically review the literature on the different physiotherapy techniques used in the treatment of FSDs. Methods: A systematic search was conducted in the databases EMBASE, PEDro, and MedLine in data as recent as June 2013, by combining words and descriptors of physical therapy treatments and female sexual dysfunctions. Excluded from review were articles concerning male sexual dysfunction, pilot studies, multicentric papers of projects, and those which were either not available in their entirety or were duplicated in another database. After the selection of studies was complete, the randomized clinical trials were scored on the PEDro Evaluation Scale. Results: Eleven articles were included, six of which went on to be qualitatively evaluated on the PEDro scale. The present study followed the methodological structure of PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies). All studies found used questionnaires to assess the effects of physical therapy on FSDs. A total of five different types of interventions were verified: kinesiotherapy (Kegel exercises and pelvic floor muscle training -PFMT), Cognitive behavioral therapy (CBT), biofeedback, electrotherapy (transcutaneous electrical stimulation -TENS, and therapeutic ultrasound -US), and manual therapy. The limitations found in this systematic review were related to the unavailability of the articles in full and the low methodological quality of the studies. Conclusion: All studies showed improvements in sexual function after physical therapy intervention. There is no consensus on any intervention with better results; however, kinesiotherapy using PFMT proved to be advantageous because of its easy application, low cost, easy learning curve, and lasting results achieved in a short period. However, there are methodological shortcomings that still need to be dealt with to determine the most suitable physical therapy treatment for FSDs, as well as defining the best dosage, the protocol to be followed, and the duration of therapy, as well as the best cost-benefit.

Physiotherapeutic resources in vaginismus

“…In the results of the Aslan study, Aslan et al [19] showed success in the treatment of vaginismus with electrostimulation (FES) used in analgesic frequency, producing a defensive reflex as a mechanism against nociception [26]. In this way, tolerance to touch was potentiated and, subsequently, there was an improvement in sexual function allowing for a satisfactory sexual relationship [27]. However, the relaxation techniques of PFM and massage must be associated, as the mobilization of tissues causes heat and helps in the organization of collagen and reduction of adhesions and can relieve local pain [28].…”

Fisioterapia nas complicações ginecológicas decorrentes do tratamento do câncer de colo de útero

“…Após a intervenção fisioterapêutica, o GAM obteve melhora estatisticamente significante, diferentemente do GDE, provavelmente pelo uso adequado do dilatador vaginal e da massagem perineal, feitos pelo profissional. Estas técnicas contribuem para reversão da dispareunia [20,23].…”

“…Contudo, o TMAP aumentou o tônus, o recrutamento das fibras e a vascularização pélvica, levando a melhora da função muscular. A massagem perineal possibilitou redução da hipertonia muscular [20,23,26]. Com este protocolo, houve melhora significativa quanto à endurance, a potência e o grau de força desses músculos, nas participantes do GAM e, no GDE, observou-se mudança estatisticamente significante apenas no que se refere as variáveis de grau de força e endurance.…”

“…O TMAP também tem sua aplicabilidade no tratamento das DS, melhora a sensibilidade clitoriana, ajuda na excitação e lubrificação, aumentando também a receptividade para a relação sexual e a satisfação com o desempenho [23]. Fatos corroborados em outra pesquisa, que apresentou melhora da função muscular, sexual e da QV de um grupo de intervenção em comparação com um grupo domiciliar controle [31].…”

Efeito da fisioterapia nos sintomas de síndrome da bexiga hiperativa decorrente do tratamento do câncer de colo de útero

“…Como forma de tratamento para a SBH, a Sociedade Internacional de Continência recomenda o método conservador, incluindo Fisioterapia e Terapia Comportamental [18]. O TMAP permite a contração e relaxamento voluntário da musculatura pélvica, estudos afirmam que esse aumenta o tônus e o recrutamento muscular local com consequente incremento da vascularização pélvica, além da conscientização e propriocepção da musculatura da região perineal e, associados com a realização da MP promovem melhora da contratilidade [19][20][21].…”