Physical therapy management of female chronic pelvic pain: Anatomic considerations

George, Susan E.; Clinton, Susan C.; Borello‐France, Diane

doi:10.1002/ca.22187

Cited by 22 publications

(7 citation statements)

References 106 publications

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“…is may hold therapeutic effects that are above and beyond the direct local influence on the muscular system [45,69]. Such relationships may involve instilling a sense of control, security, and trust, as well as self-efficacy [93], which are invaluable in improving clinical outcomes of chronic pain disorders. Furthermore, frustration resulting from the failure of previous treatments may have led women to develop negative thoughts in relation to their disease, which also manifested as catastrophic thinking when relating to their pain [94].…”

Section: Discussionmentioning

confidence: 99%

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Grinberg

Weissman-Fogel

Löwenstein³

et al. 2019

Pain Research and Management

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Background. Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder comprising structural and functional muscular abnormalities, a dysfunctional pain system, and psychological distress. Myofascial physical Therapy (MPT) that is targeted at improving pelvic muscle functioning is considered a first line nonpharmacological treatment for CPPS, although the precise mechanisms that lead to symptoms alleviation have not yet been elucidated. Purpose. This longitudinal study aimed to examine the local and systemic effects of MPT intervention, including biopsychophysiological processes, among CPPS patients. Methods. The study included 50 CPPS women. Morphologic assessment of the levator ani and quantitative sensory testing of the pain system were applied alongside with evaluation of pain-related psychological factors using designated questionnaires. All measures were evaluated both before and after MPT in 39 patients. The long-term effects of MPT were evaluated by clinical pain reports obtained at 3 and 9 months following MPT that were compared with a nontreated group of 11 untreated CPPS women. Results. Along with an improvement in the clinical pain intensity (p=0.001) and sensitivity to experimental pain tests (p=0.001) following MPT, the results also indicate that MPT has anatomical, psychological, and social therapeutic effects (p=0.04; p=0.001; p=0.01, respectively). Furthermore, clinical pain evaluation at 3 and 9 months after MPT revealed a significant improvement in women who received treatment (p=0.001). Conclusions. The findings of this pilot study suggest multisystemic (direct and indirect anatomical, neurophysiological, and psychological) effects of MPT on the multifactorial pain disorder of CPPS and therefore place MPT as a mechanism-based intervention.

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Section: Discussionmentioning

confidence: 99%

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Grinberg

Weissman-Fogel

Löwenstein³

et al. 2019

Pain Research and Management

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“…Overactive/hypertonic pelvic floor dysfunction can occur asymmetrically and/ or in specific individual muscles of the pelvic floor. Overactive/ hypertonic pelvic floor muscle dysfunction is also associated with pudendal neuropathy, 110,118 persistent pelvic pain, and vulvodynia, 119,120 as well as musculoskeletal conditions of the lumbosacral spine, pelvic girdle, coccyx, and hips, 121 which may all be associated with PGAD/GPD.…”

Section: Neurological Testingmentioning

confidence: 99%

International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

Goldstein

Komisaruk

Pukall

et al. 2021

The Journal of Sexual Medicine

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Background: Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. Aim: To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. Methods: A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. Outcomes: The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed. Results: The panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients' symptoms and the associated bother and distress. Clinical Implications: The process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment. Strengths and Limitations: Strengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the

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“…Dyspareunia is a multifactorial disorder involving biological, psychological, and social factors, and for this reason, there are many causes of dyspareunia with varying physical examination findings among patients (Howard et al, ; George et al, ; McDonald et al, ). Approximately two‐thirds of women will be affected by dyspareunia in their lifetime; with prevalence ranging between 10% to 20% in the United States (Howard et al, ; Seehusen et al, ; Sorensen et al, ).…”

Section: Etiologymentioning

confidence: 99%

The clinical anatomy of dyspareunia: A review

et al. 2018

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Dyspareunia can be described as continuous unremitting or intermittent pain associated with intercourse. It can be classified based on the location of the pain - entry or deep dyspareunia, or based on when the pain was first experienced - primary or secondary dyspareunia. There are different causes of dyspareunia and some of the most important causes include the following: vulvodynia, postpartum dyspareunia, endometriosis, inadequate vaginal lubrication or arousal, and other anogenital causes such as hemorrhoids and anal fissures. In this review, our objective is to apply the anatomical knowledge of dyspareunia to patient care, increase awareness among clinicians about the diverse etiology of dyspareunia and ensure that the whole patient, not just the pain of dyspareunia is being treated as the causes of dyspareunia can be due to various pathologies. Clin. Anat., 31:1013-1017, 2018. © 2018 Wiley Periodicals, Inc.

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Physical therapy management of female chronic pelvic pain: Anatomic considerations

Cited by 22 publications

References 106 publications

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

The clinical anatomy of dyspareunia: A review

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