Pelvic Floor Physical Therapy and Its Merit in the Treatment of Female Urogenital Pain

Purpose of Review Female urogenital pain (FUGP) affects many women and is often a diagnosis of exclusion. The long path to a diagnosis and subsequent treatment frequently leads to suffering on the individual’s behalf (Obstet. Gynecol. 121: 645–50, 2013). Additionally, this delay in diagnosis and thus treatment places stress on the US medical system (Obstet. Gynecol. 121: 645–50, 2013). There is a lack of knowledge regarding the scope of pelvic floor physical therapy (PFPT) across the medical community that may prevent physicians from referring patients (J Urol. 193:1545–53, 2015; Sex Med Rev., 2021). PFPT is a low-risk, potentially high-reward option that should be recognized as part of the multidisciplinary approach to managing FUGP. Recent Findings Research databases (PubMed and Cochrane) were used to find articles on FUGP between 2005 and 2022. Systematic reviews, randomized controlled trials (RCTs), prospective and retrospective cohorts, and case-study analyses were included in reviewing the literature. The most recent studies in the last 2 years show the benefit of PFPT in certain FUGP diagnoses with improved pain scores and function when compared to no intervention or placebo treatment. Summary The aim of this article is to elucidate the scope of PFPT in the treatment of FUGP with supporting research findings regarding efficacy. It is clear from the literature that PFPT should be recognized by referring physicians as part of a multidisciplinary approach to the treatment of FUGP. Similar content being viewed by others

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance •• Gyang A, Hartman M, Lamvu G. Musculoskeletal causes of chronic pelvic pain: What a gynecologist should know. Vol. 121, Obstetrics and Gynecology. 2013. p. 645–50. This article reviews common musckuloskeletal causes of chronic pelvic pain. It encourages routine assessment of the pelvic floor muscles at gynecologist examinations for those with pelvic or abdominal pain. Hanno PM, Erickson D, Moldwin R, Faraday MM. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA Guideline amendment. J Urol. 2015;193:1545–53. van Reijn-Baggen DA, Han-Geurts IJ, Voorham-van der Zalm PJ, Pelger RC, Hagenaars-van Miert CH, Laan ET. Pelvic floor physical therapy for pelvic floor hypertonicity: A systematic review of treatment efficacy. Sex Med Rev. 2021. Siqueira-Campos VM, de Deus MSC, Poli-Neto OB, Rosa-E-Silva JC, de Deus JM, Conde DM. Current challenges in the management of chronic pelvic pain in women: from bench to bedside. Int J Womens Health. 2022;18(14):225–44. • Huang G, Le A-L, Goddard Y, James D, Thavorn K, Payne M, et al. A Systematic review of the cost of chronic pelvic pain in women. J Obstet Gynaecol Can. 2022;44(3):286-293.e3. This systematic review concludes that trust within the therapeutic alliance, decreasing the non-clinically relevant testing, and pain neuroscience education is important in the treatment of individuals with chronic pelvic pain. As-Sanie S, Harris RE, Harte SE, Tu FF, Neshewat G, Clauw DJ. Increased pressure pain sensitivity in women with chronic pelvic pain. In: Obstetr Gynecol. 2013:1047–55. Mina M, Benfield J, Botros-Brey S, Mina C. Urogenital pain including pelvic pain. In: Shimoji K, Nader A, Hamann W, editors. Chronic pain management in general and hospital practice. Singapore: Springer Singapore. 2021:373–87. Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017;36(2):221–44. American College of Obstetricians and Gynecologists. Chronic Pelvic Pain: ACOG Practice Bulletin, Number 218. Obstet Gynecol [Internet]. 2020;135(3). Available from: https://journals.lww.com/greenjournal/Fulltext/2020/03000/Chronic_Pelvic_Pain__ACOG_Practice_Bulletin,.48.aspx. Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun D, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus terminology and classification of persistent vulvar pain and vulvodynia. J Sex Med. 2016;13(4):607–12. Loving S, Thomsen T, Jaszczak P, Nordling J. Pelvic floor muscle dysfunctions are prevalent in female chronic pelvic pain: A cross-sectional population-based study. Eur J Pain. 2014;18(9):1259–70. McLean L, Brooks K. What does electromyography tell us about dyspareunia?. Sexual Med Rev. 2017;5:282–94. Brown HW, Barnes HC, Lim A, Giles DL, McAchran SE. Better together: Multidisciplinary approach improves adherence to pelvic floor physical therapy. Int Urogynecology J. 2020;31(5):887–93. Homma Y, Akiyama Y, Tomoe H, Furuta A, Ueda T, Maeda D, et al. Clinical guidelines for interstitial cystitis/bladder pain syndrome. Int J Urol. 2020;27(7):578–89. Han E, Nguyen L, Sirls L, Peters K. Current best practice management of interstitial cystitis/bladder pain syndrome. Ther Adv Urol. 2018;10(7):197–211. Simons DG, Dommerholt J. Consensus guidelines for the management of chronic pelvic pain: J.F. Jarrell, G.A. Vilos, C. Allaire, S. Burgess, C. Fortin, R. Gerwin, L. Lapensee, R.H. Lea, N.A. Leyland, P. Martyn, H. Shenassa, P. Taenzer, B. Abu-Rafea. Obstet Gynaecol Can. 27(8):781. J Musculoskele Pain. 2006;14:62. • López-Liria R, Torres-álamo L, Vega-Ramírez FA, García-Luengo AV, Aguilar-Parra JM, Trigueros-Ramos R, et al. Efficacy of physiotherapy treatment in primary dysmenorrhea: a systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(15). This systematic review and meta-analysis found that physical therapy has a statistically significant decrease in menstrual pain intensity in individuals with dyspareunia. Menhaji K, Cardenas-Trowers OO, Chang OH, Hall EF, Ringel NE, Falk KN. Anticholinergic prescribing pattern changes of urogynecology providers in response to evidence of potential dementia risk. Int Urogynecology J. 2021;32(10):2819–26. Goldfinger C, Pukall CF, Thibault-Gagnon S, McLean L, Chamberlain S. Effectiveness of cognitive-behavioral therapy and physical therapy for provoked vestibulodynia: a randomized pilot study. J Sex Med. 2016;1(13):88–94. Twiddy H, Lane N, Chawla R, Johnson S, Bradshaw A, Aleem S, et al. The development and delivery of a female chronic pelvic pain management programme: a specialised interdisciplinary approach. Br J Pain. 2015;9(4):233–40. Chiang C-H, Jiang Y-H, Kuo H-C. Therapeutic efficacy of biofeedback pelvic floor muscle exercise in women with dysfunctional voiding. Sci Rep. 2021;11(1):13757. Payne C, Fitzgerald MP, Burks D, Nickel JC, Lukacz E, Kreder K, et al. 1035 randomized multicenter clinical trial shows efficacy of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome (IC/PBS). J Urol. 2010;183(4S). Butrick CW. Pelvic floor hypertonic disorders: identification and management. Obstetr Gynecol Clin North Am. 2009;36:707–22. Tu FF, As-Sanie S, Steege JF. Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic. J Reprod Med. 2006;51(3):185–9. Fitzgerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2013;189(1 SUPPL). Liu M, Juravic M, Mazza G, Krychman ML. Vaginal dilators: Issues and answers. Sexual Med Rev. 2021;9:212–20. Murina F, Bernorio R, Palmiotto R. The use of amielle vaginal trainers as adjuvant in the treatment of vestibulodynia: An observational multicentric study. MedGenMed Medscape Gen Med. 2008;10(1). • Padoa A, McLean L, Morin M, Vandyken C. “The Overactive Pelvic Floor (OPF) and Sexual Dysfunction” Part 1: Pathophysiology of OPF and its impact on the sexual response. Sexual Med Rev. 2021;9:64–75. This literature review explains the close interplay between overactive pelvic floor muscles and sexual dysfunction. It describes the biological and psychological factors involved. Voorham JC, De Wachter S, Van den Bos TWL, Putter H, Lycklama à Nijeholt GA, Voorham - van der Zalm PJ. The effect of EMG biofeedback assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women: A randomized controlled trial. Neurourol Urodyn. 2017;36(7):1796–803. Brellenthin AG, Crombie KM, Cook DB, Sehgal N, Koltyn KF. Psychosocial influences on exercise-induced hypoalgesia. Pain Med US. 2017;18(3):538–50. Tu FF, As-Sanie S, Steege JF. Musculoskeletal causes of chronic pelvic pain: A systematic review of existing therapies: Part II. Obstet Gynecol Surv. 2005;60(7):474–83. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of Interest The author does not have an existing conflict of Interest. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This article is part of the Topical Collection on Non-pharmacologic Aspects of Pain, Migraine, and Headache Rights and permissions Springer Nature or its licensor 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 Tracey, A. Pelvic Floor Physical Therapy and Its Merit in the Treatment of Female Urogenital Pain. Curr Pain Headache Rep 26, 775–782 (2022). https://doi.org/10.1007/s11916-022-01076-0 Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11916-022-01076-0