Simple process to asses women with pelvic pain, diffuse vulvar pain and/or dyspareunia

del Amo E1, Naranjo-Ortiz C2, Barrera E3, Montes A3

Research Type

Clinical

Abstract Category

Pelvic Pain Syndromes

Abstract 515
Open Discussion ePosters
Scientific Open Discussion Session 28
Friday 31st August 2018
13:20 - 13:25 (ePoster Station 2)
Exhibition Hall
Pain, Pelvic/Perineal Female Physiotherapy
1. Servicio de Ginecología,Hospital del Mar, Universitat Autònoma de Barcelona, Spain, 2. Escuela de Especialización Profesional de Medicina de la Educación Física y del Deporte,Universidad Complutense, Madrid, Spain, 3. Servicio de Anestesia, Hospital del Mar, Universitat Autònoma de Barcelona, Spain
Presenter
E

Elisabeth del Amo

Links

Poster

Abstract

Hypothesis / aims of study
Pain perceived inside the pelvis may arise from various mechanisms, many of which are still not well understood. Some processes have been 'well defined' over the years and it is very important to identify and treat them through a strategy based on scientific evidence, for example, pudenda neuralgia. The aim of this project is to suggest an easy process to assess women with pelvic pain, diffuse vulvar pain and/or dyspareunia.
Study design, materials and methods
Descriptive study about the first pelvic pain visits made in 2017 in gynaecology office.
Results
19 patients, average age: 40.1 years (range 25-58 years)
Average time of evolution pain prior to the visit: 28.94 months (range 3-132 months)
Evaluation time after applying pelvic relaxation: average 6 months ( range 2-12 months), 1 dropout patient

Primary Source of Pain	                             Patients  	     %
Pelvic Pain	                                                         11	         57.89
Dysmenorrhea	                                                   3	         15.78
Dyspareunia	                                                           3	         15.78
Vulvodinia	                                                           1	           5.26
Perineal Pain	                                                           1       	   5.26


Pain Association	                                             Patients	     %
Only pelvic pain 	                                                    5	          26.31
Pelvic pain and dysmenorrhea                              4	          21
Pelvic pain and dyspareunia 	                            2	          10.52
Only dysmenorrhea 	                                            1	            5.26
Dysmenorrhea and dyspareunia                          3	         15.78
Only dyspareunia 	                                            2	         10.52
Vulvodinia and dyspareunia                                  1	           5.26
Perineal pain and dyspareunia                             1	           5.26

Exploration Findings	                                     Patients	     %
Pelvis asymmetry	                                                   2	         10.52
Painful abdominal scars	                                   2	         10.52
Hypertonicity of levator ani                                19	       100
Hypertonicity of iliopsoas muscle                      11	         57.89
Piriformis pain 	                                                   1	           5.2
Peripherical neuropathy	                                   5	         26.31
           
Symptomatology after Pelvic Relaxation	     Patients	     %
Asymptomatic/almost asymptomatic	           7	         36.84
Improvement	                                                   7	         36.84
Little/no improvement	                                   4	         21.05
Dropout patients	                                                   1	           5.26

Months until patients reported improvement after applying pelvic relaxation: average 6 months (range 2-12 months), 1 dropout patient
Interpretation of results
Most of the patients who come with pelvic pain, diffuse vulvar pain and/or dyspareunia to the gynaecologist's office also have pelvic muscle pain that worsens their symptoms. 100% of our patients had hypertonicity of the elevator ani muscle and 57.89% hypertonicity of the iliopsoas muscle when we explored them. We also found 26.31% of them with pudendal o cluneal neuropathy.
Even though 57.91% of patients had two associated pain symptoms, after doing pelvic relaxation, 73.68% of all patients had either total or near total improvement. Patients needed an average of 6 months until they reported improvement.
Concluding message
Physical examination is an essential procedure in the assessment of all patients. A physical examination is needed to rule out functional pathologies associated with organic pathologies. 
We focused often on organic pathologies and we wasted a lot of time making unnecessary complementary explorations without paying carefully attention to physical examination.
Properly functioning pelvic floor muscles improve  the symptoms of women with pelvic pain and/or dyspareunia and dysmenorrhea.  We propose a simple exploration algorithm (Figure 1) for the first gynaecological visit. And if we find any musculoskeletal involvement in the physical exploration, we would recommend physiotherapist treatment as a priority.
Figure 1
References
  1. Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., . . . Standardisation Sub-committee of the International Continence, S. (2002). The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn, 21(2), 167-178
  2. Slieker-ten Hove, M. C., Pool-Goudzwaard, A. L., Eijkemans, M. J., Steegers-Theunissen, R. P., Burger, C. W., & Vierhout, M. E. (2009). Pelvic floor muscle function in a general female population in relation with age and parity and the relation between voluntary and involuntary contractions of the pelvic floor musculature. Int Urogynecol J Pelvic Floor Dysfunct, 20(12), 1497-1504. doi:10.1007/s00192-009-0978-7
  3. Carrière, B., Markel Feldt, C. The Pelvic Floor. (2006) Ed. George Thieme Verlag. Stuttgard, New York
Disclosures
Funding No Clinical Trial No Subjects Human Ethics Committee CEIC-Parc de Salut Mar Helsinki Yes Informed Consent Yes
12/03/2024 12:31:26