Sensory and muscular functions of the pelvic floor in women with endometriosis - cross-sectional study

Purpose The aim of this study was to analyze the sensory and muscle functions of the pelvic floor in women with endometriosis, trying to improve overall knowledge/findings regarding pelvic floor muscle functions in patients with endometriosis.

Sample size calculated as 92 patients with endometriosis, aged between 18 and 45 years, not virgin, without other causes of pain and could not be pregnant. Patients underwent the Pelvic Floor Sensorial and Muscle Function Exam (EFSMAP). Descriptive data were recorded with mean and standard deviation, median (range), and absolute and relative frequency. The Kolmogorov–Smirnov test was used to observe the normality of quantitative variables. The significance level adopted for this study was 5%.

Of 92 women assessed, 93.3% had pain and 75% had increased tone in the levator ani muscle; 50.4% had impaired pelvic floor relaxation with median strength of 3 by the Oxford scale and endurance of 2 s.

The patients had a high prevalence of pain and dysfunction of the pelvic floor muscles, such as low muscle endurance and difficulty to relax. It shows that these patients should be referred to a pelvic floor physiotherapist, as soon as they have the diagnosis of endometriosis, to be assessed to prevent and/or treat pelvic floor impairments. Similar content being viewed by others Data availability The data that support the findings of this study are available from the corresponding author, [CWSF], upon reasonable request.

Vercellini P, Viganò P, Somigliana E, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 10(5):261–275. https://doi.org/10.1038/nrendo.2013.255 Aredo JV, Heyrana KJ, Karp BI, Shah JP, Stratton P (2017) Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Semin Reprod Med. 35(1):088–097. https://doi.org/10.1055/s-0036-1597123 Oliveira R, Musich DS, Ferreira MPSF, Vilarino FL, Barbosa CP (2015) Epidemiological profile of infertile patients with endometriosis. Reprod Climaterium 30(1):5–10. https://doi.org/10.1016/j.recli.2015.03.005 Hodges PW, Sapsford R, Pengel LHM (2007) Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn 26:362–371. https://doi.org/10.1002/nau.20232 Mieritz MR, Thorhauge K, Forman A, Mieritz HB, Hartvigsen J, Christensen HW (2016) Musculoskeletal dysfunctions in patients with chronic pelvic pain: a preliminary descriptive survey. J Manipulative Physiol Ther 39(9):616–622. https://doi.org/10.1016/j.jmpt.2016.09.003 Vieira GF, Saltiel F, Miranda-Gazzola APG, Kirkwood RN (2019) Pelvic floor muscle function in women with and without urinary incontinence: are strength and endurance the only relevant functions? A cross-sectional study. Physiotherapy 109:85–93. https://doi.org/10.1016/j.physio.2019.12.006 Laycock JO, Jerwood D (2001) Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy 8(12):631–642. https://doi.org/10.1016/S0031-9406(05)61108-X Cardoso JV, Machado DE, Silva MC, Berardo PT, Ferrari R, Abrão MS, Perini JA (2020) Epidemiological profile of women with endometriosis: a retrospective descriptive study. Revista Brasileira de Saúde Materno Infantil 20(4):1057–1067. https://doi.org/10.1590/1806-93042020000400008 Santulli P, Chouzenoux S, Fiorese M, Marcellin L, Lemarechal H, Millischer AE, Batteux F, Borderie D, Chapron C (2015) Protein oxidative stress markers in peritoneal fluids of women with deep infiltrating endometriosis are increased. Hum Reprod 30(1):49–60. https://doi.org/10.1093/humrep/deu290 Santulli P, Borghese B, Noël JC, Fayt I, Ziegler VAD, Batteux F, Vaiman D, Chapron C (2014) Hormonal therapy deregulates prostaglandin-endoperoxidase synthase 2 (PTGS2) expression in endometriotic tissues. J Clin Endocrinol Metab 99(3):881–890. https://doi.org/10.1210/jc.2013-2950 Chapron C, Lang J-H, Leng J-H, Zhou Y, Zhang X, Xue M, Popov A, Romanov V, Maisonobe P, Cabri P (2016) Factors and regional differences associated with endometriosis: a multi-country case–control study. Adv Ther 33(8):1385–1407. https://doi.org/10.1007/s12325-016-0366-x Škegro B, Bjedov S, Mikuš M, Mustač F, Lešin J, Matijević V, Ćorić M, Elveđi Gašparović V, Medić F, Sokol Karadjole V (2021) Endometriosis, pain and mental health. Psychiatr Danub 33(Suppl 4):632–636 (PMID: 34718292) Prescott J, Farland LV, Tobias DK, Gaskins AJ, Spiegelman D, Chavarro JE, Rich-Edwards JW, Barbieri RL, Missmer SA (2016) A prospective cohort study of endometriosis and subsequent risk of infertility. Hum Reprod 31(7):1475–1482. https://doi.org/10.1093/humrep/dew085 Mikuš M, Matak L, Vujić G, Škegro B, Škegro I, Augustin G, Lagana AS, Ćorić M (2023) The short form endometriosis health profile questionnaire (EHP-5): psychometric validity assessment of a croatian version. Arch Gynecol Obstet 307(1):87–92. https://doi.org/10.1007/s00404-022-06691-1 Efstathiou M, Giannaki C, Roupa Z, Hadjisavvas S, Stefanakis M (2022) Evidence of distorted proprioception and postural control in studies of experimentally induced pain: a critical review of the literature. Scand J Pain 22(3):445–456. https://doi.org/10.1515/sjpain-2021-0205 Bonder JH, Chi M, Rispoli L (2017) Myofascial pelvic pain and related disorders. Phys Med Rehabil Clin 28(3):501–515. https://doi.org/10.1016/j.pmr.2017.03.005 Lamvu G, Carrillo J, Witzeman K, Alappattu M (2018) Musculoskeletal considerations in female patients with chronic pelvic pain. Semin Reprod Med. 36(2):107–115. https://doi.org/10.1055/s-0038-1676085 Gümüşsoy S, Öztürk R, Kavlak O, Hortu İ, Yeniel AÖ (2021) Investigating pelvic floor muscle strength in women of reproductive age and factors affecting it. Clin Nurs Res 30(7):1047–1058. https://doi.org/10.1177/10547738211000350 Mikuš M, Kalafatić D, Vrbanić A, Šprem Goldštajn M, Herman M, Živković Njavro M, Živković K, Marić G, Ćorić M (2022) Efficacy comparison between kegel exercises and extracorporeal magnetic innervation in treatment of female stress urinary incontinence: a randomized clinical trial. Medicina (Kaunas) 58(12):1863. https://doi.org/10.3390/medicina58121863 Mikuš M, Laganà AS, Chiantera V, Ćorić M (2022) Digital therapeutic device for urinary incontinence: a randomized controlled trial. Obstet Gynecol 140(1):136. https://doi.org/10.1097/AOG.0000000000004843. (PMID: 35849471) Weinstein MM, Dunivan G, Guaderrama NM, Richter HE (2022) Digital therapeutic device for urinary incontinence: a randomized controlled trial. Obstet Gynecol 139(4):606–615. https://doi.org/10.1097/AOG.0000000000004725 Martins M, Dreher DZ, Callegaro CC, Berlezi EM (2019) Confiabilidade e concordância intra e inter avaliadores na avaliação da pressão perineal em nulíparas. Scientia Medica 29(1):e32614. https://doi.org/10.15448/1980-6108.2019.1.32614 Fraga MV, Oliveira BLG, Yela DA, de Mira TA, Benetti-Pinto CL (2021) Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: an underestimated association. Int J ClinPract 75(8):e14350. https://doi.org/10.1111/ijcp.14350 Gyang A, Hartman M, Lamvu G (2013) causes of chronic pelvic pain: what a gynecologist should know. Obstet Gynecol 121(3):645–650. https://doi.org/10.1097/AOG.0b013e318283ffea Cameron B, Sabourin J, Sanaee MS, Koenig NA, Lee T, Geoffrion R (2019) Pelvic floor hypertonicity in women with pelvic floor disorders: a case control and risk prediction study. Neurourol Urodyn 38(2):696–702. https://doi.org/10.1002/nau.23896

The authors would like to thank Mr. Craig Bernard Donnelly for proofreading the manuscript regarding English, as a native English Speaker, the Federal University of Pernambuco (UFPE) and the Coordination for the Improvement of Higher Education Personnel (CAPES) for the financial support. Funding Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Universidade Federal de Pernambuco. Author information Authors and Affiliations Contributions JPS: project development, data collection, data analysis, interpretation of data, manuscript writing, approval of the final version. BMA: data collection, data analysis, interpretation of data, manuscript writing, approval of the final version. RSF: data collection, data analysis, approval of the final version. CRPOL: data analysis, interpretation of data, revision of the manuscript, approval of the final version. LMAB: project development, data analysis, interpretation of data, revision of the manuscript, approval of the final version. CWSF: project development, data analysis, interpretation of data, revision of the manuscript, approval of the final version. Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical approval and consent to participate This study was conducted in accordance with the terms of the National Health Council (Resolution 466/12) and was approved by the Ethics and Human Research Committee of the Federal University of Pernambuco, approval number 4,627,309. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article da Silva, J.P., de Almeida, B.M., Ferreira, R.S. et al. Sensory and muscular functions of the pelvic floor in women with endometriosis – cross-sectional study. Arch Gynecol Obstet 308, 163–170 (2023). https://doi.org/10.1007/s00404-023-07037-1 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-023-07037-1