title: Physical Therapy in the Treatment of Central Pain Mechanisms for Female Sexual Pain.
abstract: BACKGROUND
  The complexity of female sexual pain requires an interdisciplinary approach. Physical therapists trained in pelvic health conditions are well positioned to be active members of an interdisciplinary team addressing the assessment and treatment of female sexual pain. Changes within physical therapy practice in the last ten years have resulted in significant utilization of pelvic floor muscle relaxation and manual therapy techniques to address a variety of pelvic pain conditions, including female sexual pain. However, sexual pain is a complex issue giving credence to the necessity of addressing all of the drivers of the pain experience- biological, psychological and social.
  
  
  OBJECTIVE
  This review aims to reconcile current pain science with a plan for integrating a biopsychosocial approach into the evaluation and subsequent treatment for female sexual pain for physical therapists.
  
  
  METHODS
  A literature review of the important components of skilled physical therapy interventions is presented including the physical examination, pain biology education, cognitive behavioral influences in treatment design, motivational interviewing as an adjunct to empathetic practice, and the integration of non-threatening movement and mindfulness into treatment.
  
  
  METHODS
  A single case study is used to demonstrate the biopsychosocial framework utilized in this approach.
  
  
  RESULTS
  Appropriate measures for assessing psychosocial factors are readily available and inform a reasoned approach for physical therapy design that addresses both peripheral and central pain mechanisms. Decades of research support the integration of a biopsychosocial approach in the treatment of complex pain, including female sexual pain.
  
  
  CONCLUSIONS
  It is reasonable for physical therapists to utilize evidence based strategies such as CBT, pain biology education, Mindfulness Based Stress Reduction (MBSR), yoga and imagery based exercises to address the biopsychosocial components of female sexual pain.
authors: Pelvic Health Solutions, Cambridge, ON, Canada. Electronic address: Carolyn@pelvichealthsolutions.ca.
authors: Carolyn
authors: C
authors: Vandyken
authors: Entropy Physiotherapy and Wellness, Chicago, IL, USA.
authors: Sandra
authors: S
authors: Hilton
keywords: Biopsychosocial; Central Pain; Pain Biology Education; Pelvic Pain; Physical Therapy; Sexual Pain