title: A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain.
abstract: OBJECTIVE
  Our aim was to determine the effects of pelvic floor physical therapy (PT) and levator-directed trigger-point injections (LTPI) on sexual function and levator-related pelvic pain.
  
  
  METHODS
  A randomized trial among women with pelvic floor myalgia (PFM) was performed wherein participants received either PT or LTPI. Pain was assessed and 1 month posttreatment completion. Levator-based pain was assessed using a numeric rating scale (NRS) and the Patient Global Impression of Improvement (PGI-I) scale. Sexual function was assessed using the Female Sexual Function Index (FSFI).
  
  
  RESULTS
  Twenty-nine women completed the study (17 had PT, 12 had LTPI). Both groups reported reduction in vaginal pain: mean NRS change from baseline of 4.47 [standard deviation (SD) 2.12) for PT and 4.67 (SD 1.72) for LTPI (p = 0.8)]. A >50 % improvement in NRS was documented among 59 % of women receiving PT and 58 % receiving LTPI (p = 1.0). Consistent with NRS scores, mean PGI-I score was 2.50 (SD 1.17) for PT and 2.17 (SD 1.01) for LTPI (p = 0.5). Mean change in FSFI favored PT [PT +8.87 (SD 5.60), LTPI +4.00 (SD 5.24), p = 0.04], reflecting improvement in the sexual pain domain favoring PT (p = 0.02). However, the time in weeks to effect improvement favored LTPI if controlling for the degree of change in NRS (p = 0.01) and FSFI (p = 0.01).
  
  
  CONCLUSIONS
  Vaginal myalgia and sex-related pain improved with pelvic floor PT and LTPI. Time-to-effect improvement and significance of therapy are dependent on treatment type.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine And Reconstructive Surgery, University Of Kansas Medical Center, 3901 Rainbow Blvd, MS 2028, Kansas City, KS, 66160, USA, dzobgyn@gmail.com.
authors.forename: Dani
authors.initials: D
authors.lastname: Zoorob
authors.forename: Mary
authors.initials: M
authors.lastname: South
authors.forename: Mickey
authors.initials: M
authors.lastname: Karram
authors.forename: Julie
authors.initials: J
authors.lastname: Sroga
authors.forename: Rose
authors.initials: R
authors.lastname: Maxwell
authors.forename: Aparna
authors.initials: A
authors.lastname: Shah
authors.forename: James
authors.initials: J
authors.lastname: Whiteside
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001004:Anus Diseases / Q000628:therapy*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections / Q000379:methods*; D008405:Massage; D008875:Middle Aged; D063806:Myalgia / Q000628:therapy*; D009209:Myofascial Pain Syndromes / Q000628:therapy*; D010146:Pain; D059952:Pelvic Floor Disorders; D010865:Pilot Projects; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*; D061028:Trigger Points
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D014221:Triamcinolone; D002045:Bupivacaine