Ultrasonography Comparison of Pelvic Floor and Abdominal Wall Muscles in Women with and without Dyspareunia: A Cross-Sectional Study

Abstract

Pelvic floor hypertonicity and narrowing of the levator ani hiatus is traditionally assumed in women with dyspareunia and considered a therapeutical target by physical therapists. However, accurate pre-treatment assessment of pelvic floor muscles is difficult to perform in clinical sites. In addition, the abdominal musculature has not been evaluated in this population, despite its relationship with pelvic floor disfunctions. The purpose of this study was to determine the existence of differences in the length of the anteroposterior diameter of the levator ani hiatus (APDH), the thickness of the abdominal wall musculature and the interrecti distance (IRD) in subjects with dyspareunia compared to a control group. A cross-sectional observational study was designed using ultrasound imaging to measure the APH, the thickness of the abdominal musculature—rectus abdominis (RA), transverse abdominis (TrAb), internal oblique (IO), external oblique (EO)—and IRD at rest and during contraction. Thirty-two women were recruited through advertising and social webs and divided into two groups: dyspareunia (n = 16) and no dyspareunia (n = 16). There were no statistically significant differences (p < 0.05) in RA, TrAb, OI and OE muscle thickness. No differences in APH or in supraumbilical and infraumbilical IRD were found. The findings of this study suggest that the relationship between the abdominal structure/levator ani hypertonia and dyspareunia remains uncertain.

Technical aspects of inter-recti distance measurement with ultrasonographic imaging for physiotherapy purposes: the scoping review

“…All 49 included publications (published between 2008 and August 2022) were related to physiotherapy or physical exercise/training and described IRD measurements using USI. Eight studies were from Canada [8,17,20,33,48,[53][54][55] and nine from Spain [11,[42][43][44][45][56][57][58][59]. Countries with two studies were Brazil [60,61], the USA [9,62], the UK [16,63], Norway [13,37], New Zealand [47,64], and China [65,66].…”

“…Of the 30 protocols using flexed lower extremities, in 26 examinees' feet were supported on the examination table [9-11, 13, 15, 17, 27, 34-37, 45, 47, 49, 60-64, 67, 68, 71-75] (16 specified that knee flexion angle was 90° [11, 15, 27, 35-37, 47, 49, 63, 64, 67, 68, 71-73, 75]), in 3, one [56] or two pillows [16,18] were placed under the examinees' knees, and in one the method of obtaining lower extremity flexion was not specified [57] (Table 2).…”

“…(26 of these protocols used both locations [9, 10, 13, 18, 20, 27, 33, 35, 37, 47-49, 55-57, 61-65, 67, 71-75].) Supraumbilical measurements were made at 2 cm [12,13,35,37,47,49,56,64,[70][71][72][73][74][75], 2.5 cm [18,69], 3 cm [8,10,17,20,27,33,48,53,55,60,61,66], 4.5 cm [9,57,62,67,68], 5 cm [8,17,20,33,35,48,53,55,72], and 6, 9, and 12 cm [60] above the umbilicus; a third of the distance [63] and halfway [11,34,74] between the umbilicus and xiphoid, and at subxiphoid and epigastric si...…”

Multifunctional Evaluation Technology for Diagnosing Malfunctions of Regional Pelvic Floor Muscles Based on Stretchable Electrode Array Probe

“…At present, specific functional information of PFM can be obtained using various detection systems. Ultrasound is a well-used tool to check the disease status [ 8 , 9 , 10 ]. Magnetic resonance imaging technology can also be applied to detect the symmetry and coordination of PFM [ 11 ].…”

Hypoxia as a potential cause of dyspareunia

“…it is only present with penile-vaginal penetration and not followed by any other condition [ 1 , 10 ]. This dysfunction is very often associated with painful spasms of the pelvic muscles [ 11 , 12 ].…”