P10.06: Pelvic floor morphometry at 3D/4D transperineal ultrasound in women with endometriosis and dyspareunia before and after pelvic floor physiotherapy

To assess the effect of pelvic floor physiotherapy on levator hiatal area (LHA) and dyspareunia in women with deep infiltrating endometriosis (DIE). We recruited a series of nulliparous women with a sonographic diagnosis of DIE and associated dyspareunia between June 2018 and March 2019. All women underwent an initial evaluation for superficial and deep dyspareunia using a Numerical Rating Scale (NRS) and a 3D/4D transperineal ultrasound for evaluation of LHA at rest, at maximum pelvic floor muscle (PFM) contraction and during maximum Valsalva maneuver by the same operator. Moreover, physical examination by an experienced pelvic floor physiotherapist was performed. Subsequently, women underwent five individual sessions of pelvic floor physiotherapy at weeks 1, 3, 5, 8, 11 from the first examination. Following the conclusion of the therapy sessions, dyspareunia scores and LHA were reassessed and compared with pre-therapy data. All LHA measurements were performed offline anonymously by an investigator blinded to the clinical data. Overall 19 women were enrolled, among which 12 had complete data. In comparison with pre-therapy data, post-therapy LHA were larger at rest (post 12.1 [7.8-15.3] vs pre 10.1 [7.5-15.2], p = 0.049), at maximum Valsalva maneuver (post 14.0 [9.4-18.3] vs pre 11.9 [8.8-16.2], p = 0.041) and at maximum PFM contraction (post 8.3 [6.8-16.9] vs pre 10.5 [7.3-15.2], p = 0.05), although this latter did not reach statistical significance. Moreover, after physiotherapy NRS scores were significantly reduced, both for superficial and deep dyspareunia (post 3 [0-8] vs pre 8 [4-10], p = 0.004 for superficial dyspareunia; post 4 [0-10] vs pre 7 [0-10], p = 0.04 for deep dyspareunia). Data are expressed as median [range]. Targeted physiotherapy seems to improve PFM dysfunction in women with DIE. Furthermore, pelvic floor physiotherapy may be effective in the reduction of both superficial and deep dyspareunia in these women. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.