The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients

Padoa, Anna; McLean, Linda; Morin, Mélanie; Vandyken, Carolyn

doi:10.1016/j.sxmr.2020.04.002

Cited by 29 publications

(32 citation statements)

References 123 publications

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“…Manometry which measures the vaginal squeeze pressure can be considered to represent strength and actual capacity of the woman 1 . However, its results are not directive measurement of PFM activity and cannot reflect PFM resting tone 29 . Electromyography is the only method to measure PFM activity directly, capture PFM endurance and voluntary activity, and possible neuromuscular injury to pelvic floor caused by vaginal delivery 29 .…”

Section: Discussionmentioning

confidence: 99%

“… 1 However, its results are not directive measurement of PFM activity and cannot reflect PFM resting tone. 29 Electromyography is the only method to measure PFM activity directly, capture PFM endurance and voluntary activity, and possible neuromuscular injury to pelvic floor caused by vaginal delivery. 29 Although mediolateral episiotomy has been documented to result in a decrease in injury to the levator ani muscle and occurrence of pelvic floor disorders, 4 the small but significant difference of sEMG between both groups indicated the possible influence of episiotomy on imbalance in the muscular tissue or even reinnervation.…”

Section: Discussionmentioning

confidence: 99%

“… 29 Electromyography is the only method to measure PFM activity directly, capture PFM endurance and voluntary activity, and possible neuromuscular injury to pelvic floor caused by vaginal delivery. 29 Although mediolateral episiotomy has been documented to result in a decrease in injury to the levator ani muscle and occurrence of pelvic floor disorders, 4 the small but significant difference of sEMG between both groups indicated the possible influence of episiotomy on imbalance in the muscular tissue or even reinnervation. Our results confirm that sEMG recordings are a useful tool in understanding both neural control of the pelvic floor and its pathology in cases of neurological or traumatic lesions that may result in UI.…”

Section: Discussionmentioning

confidence: 99%

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Two year follow‐up and comparison of pelvic floor muscle electromyography after first vaginal delivery with and without episiotomy and its correlation with urinary incontinence: A prospective cohort study

Dong

Lyu

et al. 2022

Acta Obstet Gynecol Scand

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Introduction Few prospective studies have revealed the long‐term neuromuscular alterations of pelvic floor after vaginal delivery. The aim of this study was to evaluate the impact of episiotomy on the electrical activity of pelvic floor muscle 2 years following vaginal delivery, and explore the relation between surface electromyography (sEMG) amplitudes and urinary incontinence. Material and methods A total of 427 primiparous women with full‐term singleton vaginal delivery were included in the cohort and 362 with no further births within the 2 year follow‐up completed observations. Of these, 200 underwent episiotomy and 162 underwent nonepisiotomy. Clinical demographic characteristics, vaginal EMG variables and urinary incontinence‐specific questionnaire scores were collected at 6 weeks, 6, 12 and 24 months after childbirth, respectively. Primary outcomes were the comparison of sEMG values between the episiotomy and nonepisiotomy groups throughout 2 years. Secondary outcomes were the correlation between sEMG of both groups and the incidence and severity of urinary incontinence. Spearman's correlation analysis, Kruskal‐Wallis test and ANOVA with Bonferroni correction were used to analyze the variables. Results Amplitude of maximal fast and endurance contractions on sEMG in the episiotomy group was significantly lower than the nonepisiotomy counterpart. Such difference of sEMG persisted for a long period after birth: endurance contraction, 33.12 ± 8.92 vs 35.085 ± 9.98, p < 0.01 at 24 months, and fast contraction, 36.53 ± 8.87 vs 39.05 ± 9.98, p = 0.01 at 12‐month. Although there was no significant difference in incidence and severity of urinary incontinence between both groups, a negative correlation existed between EMG values of muscle contraction and urinary incontinence symptoms throughout. Conclusions Primiparous women delivered with episiotomy demonstrated lower contractile sEMG activity of pelvic floor muscle in the long term. The lower sEMG values of fast contraction were associated with urinary incontinence symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Two year follow‐up and comparison of pelvic floor muscle electromyography after first vaginal delivery with and without episiotomy and its correlation with urinary incontinence: A prospective cohort study

Dong

Lyu

et al. 2022

Acta Obstet Gynecol Scand

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“…Women who are nonresponsive to standard conservative therapy may be considered for other nonsurgical treatments, including behavioral modification, acupuncture, trigger point injections, 8 off-label use of botulinum toxin injections, 9 and off-label use of intravaginal diazepam. 3,10 Systemic pharmacologic therapies such as anticholinergics, smooth muscle relaxants, anticonvulsants, and selective serotonin norepinephrine reuptake inhibitors are often used to address pain, but these therapies may have higher rates of side effects, especially sedation and cognitive inhibition. 3,10,11 Diazepam has been used as a second-line therapy because it can be administered intravaginally, which may decrease the incidence of systemic side effects.…”

mentioning

confidence: 99%

“…3,10 Systemic pharmacologic therapies such as anticholinergics, smooth muscle relaxants, anticonvulsants, and selective serotonin norepinephrine reuptake inhibitors are often used to address pain, but these therapies may have higher rates of side effects, especially sedation and cognitive inhibition. 3,10,11 Diazepam has been used as a second-line therapy because it can be administered intravaginally, which may decrease the incidence of systemic side effects.…”

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confidence: 99%

A Systematic Review of Intravaginal Diazepam for the Treatment of Pelvic Floor Hypertonic Disorder

Stone

Abousaud

et al. 2020

The Journal of Clinical Pharma

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This systematic review evaluates the efficacy of intravaginal diazepam in treating chronic pelvic pain and sexual dysfunction associated with high‐tone pelvic floor dysfunction. A literature search was conducted in Medline and Web of Science, including articles from the database's inception to July 2019. The search identified 126 articles, and 5 articles met study inclusion criteria: 2 observational reviews and 3 small randomized, controlled trials (RCTs) evaluating intravaginal diazepam for high‐tone pelvic floor dysfunction. The 2 observational studies identified subjective reports of improvement in sexual function for a majority of women, 96% and 71%, in each study. However, there were no statistical differences between Female Sexual Function Index (FSFI) and Visual Analog Scale (VAS) scores for pain identified. One RCT found no significant changes between groups in median FSFI or VAS scores, and a second RCT found no significant changes between groups in 100‐mm VAS scores. The third RCT demonstrated that compared with placebo, treatment with transcutaneous electrical nerve stimulation and intravaginal diazepam for women with vestibulodynia and high‐tone pelvic floor dysfunction yielded significant differences in reduction of dyspareunia (P ≤ .05), ability to relax pelvic floor muscles after contraction (P ≤.05), and current perception threshold values at a 5‐Hz stimulation related to C fibers (P < .05), but no significant changes in 10‐cm VAS scores. Intravaginal diazepam may be helpful in women with a specific diagnosis of high‐tone pelvic floor dysfunction, but more and larger studies are needed to confirm these potential effects.

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Comparing male and female pelvic floor muscle function by the number and type of pelvic floor symptoms

Notenboom‐Nas

Vries

Dekker

et al. 2023

Neurourology and Urodynamics

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Pelvic floor symptoms (PFS), including lower urinary tract symptoms, defecation problems, sexual dysfunction, and pelvic pain, are common in males and females. Comparing pelvic floor musculature (PFM) function between sexes may reveal important differences relevant to clinical care. This study aimed to compare male and female PFM function and to assess the function of both sexes with the number and type of PFS.Methods: We purposively enrolled males and females aged ≥ 21 years with 0-4 PFS based on questionnaire responses in an observational cohort study.Participants then underwent PFM assessment, and muscle function in the external anal sphincter (EAS) and puborectal muscle (PRM) were compared between sexes. The relationships between muscle function and the number and type of PFS were explored. Results: Of the invited 400 males and 608 females, 199 and 187 underwent PFM assessment, respectively. Compared with females, males more often showed increased EAS and PRM tone during assessments. Compared with males, females more often showed weaker maximum voluntary contraction (MVC) of the EAS and dysfunctional endurance of both muscles; additionally, those with zero or one PFS, sexual dysfunction, and pelvic pain more often showed a weak MVC of the PRM. Conclusions: Despite a few similarities between males and, females we found differences in muscle tone, MVC, and endurance between male and female PFM function. These findings provide useful insights into the differences in PFM function between males and females.

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The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients

Cited by 29 publications

References 123 publications

Two year follow‐up and comparison of pelvic floor muscle electromyography after first vaginal delivery with and without episiotomy and its correlation with urinary incontinence: A prospective cohort study

Two year follow‐up and comparison of pelvic floor muscle electromyography after first vaginal delivery with and without episiotomy and its correlation with urinary incontinence: A prospective cohort study

A Systematic Review of Intravaginal Diazepam for the Treatment of Pelvic Floor Hypertonic Disorder

Comparing male and female pelvic floor muscle function by the number and type of pelvic floor symptoms

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