Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program.
BACKGROUND
Physical therapy (PT) may reduce the pain associated with provoked vestibulodynia (PVD) based on previous findings that pelvic floor muscle dysfunction (PFMD) is associated with PVD symptoms.


OBJECTIVE
The goals of this study were: (i) to determine whether women with and without PVD differ on measures of pelvic floor muscle (PFM) behavior; and (ii) to assess the impact of PT treatment for women with PVD on these measures.


METHODS
Eleven women with PVD and 11 control women completed an assessment evaluating PFM behavior using surface electromyography (SEMG) recordings and a digital intravaginal assessment. Women with PVD repeated the assessment after they had undergone eight PT treatment sessions of manual therapy, biofeedback, electrical stimulation, dilator insertions, and home exercises.


METHODS
Superficial and deep PFM SEMG tonic activity and phasic activity in response to a painful pressure stimulus, PFM digital assessment variables (tone, flexibility, relaxation capacity, and strength).


RESULTS
At pretreatment, women with PVD had higher tonic SEMG activity in their superficial PFMs compared with the control group, whereas no differences were found in the deep PFMs. Both groups demonstrated contractile responses to the painful pressure stimulus that were significantly higher in the superficial as compared with the deep PFMs, with the responses in the PVD group being higher than those in control women. Women with PVD had higher PFM tone, decreased PFM flexibility and lower PFM relaxation capacity compared with control women. Posttreatment improvements included less PFM responsiveness to pain, less PFM tone, improved vaginal flexibility, and improved PFM relaxation capacity, such that women with PVD no longer differed from controls on these measures.


CONCLUSIONS
Women with PVD demonstrated altered PFM behavior when compared with controls, providing empirical evidence of PFMD, especially at the superficial layer. A PT rehabilitation program specifically targeting PFMD normalized PFM behavior in women with PVD.
Gentilcore-Saulnier
Evelyne
E
School of Rehabilitation Therapy, Queen's University, Kingston, Ontario K7L3N6, Canada.
McLean
Linda
L
Goldfinger
Corrie
C
Pukall
Caroline F
CF
Chamberlain
Susan
S
D001676:Biofeedback, Psychology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004558:Electric Stimulation; D004576:Electromyography; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D053580:Muscle Strength; D026201:Musculoskeletal Manipulations; D010147:Pain Measurement; D017773:Pelvic Floor / Q000473:pathology / Q000503:physiopathology*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D056650:Vulvodynia / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*