Fibromyalgia (FM) is a chronic musculoskeletal pain syndrome defined by generalized and complex pain of idiopathic origin (1). It is estimated that the prevalence of FM in the world population varies between 0.2 and 6.6% (2). Women with FM have higher levels of premenstrual discomfort, dysmenorrhea, and frequent reports of pelvic floor dysfunction symptons(3). However, the literature on the subject is scarce. To better understand the relationship between FM and pelvic floor dysfunctions, we performed an integrative literature review. This integrative literature review aims to investigate pelvic floor dysfunctions in women diagnosed with FM.

Study design:Integrative literature review.
Materials and methods: The following steps were proceeded to elaborate this integrative review: establishment of the integrative review hypothesis and objectives; establishment of the inclusion and exclusion criteria of articles (sample selection); selection of information to be extracted from them; results analysis; results presentation and discussion, and the last step consisted in the review presentation. To guide the integrative review, the following guiding question was formulated: What is the frequency of pelvic floor dysfunction in women with FM? A bibliographic search was conducted from November 2017 to January 2018 in five databases (MEDLINE, PubMed, PEDro, Scielo and Central Cochrane Library) using the key terms "Fibromyalgia" and "Pelvic Floor" and their equivalents in Portuguese and Spanish ("Fibromialgia" and "Diafragma da pelve", "Fibromialgia" and "Diafragma pélvico", respectively) and in accordance with the Health Sciences Descriptors (DeCS). On the databases that were permitted, "AND" was used as Boolean operator. Were  considered as inclusion criteria: Articles which methodology were classified as levels of evidence 1, 2, and 4, i.e. systematic reviews of multiple randomized controlled trials, individual randomized controlled trials, studies with a quasi-experimental research design, descriptive studies (non-experimental) or with a qualitative approach that addressed the frequency of pelvic floor dysfunction in women with FM comparing it or not with non-diagnosed women, published between 2012 and 2017, that had available full text. The exclusion criteria were: articles which sample involved not just women, but men or under-18-year-old individuals, and articles that were written in another language except English, Portuguese or Spanish. The first selection was done by two researchers individually, based on the titles and the articles abstract, obtaining the full version for eligibility confirmation and inclusion in the study. Those which did not meet the inclusion criteria or presented some of the exclusion criteria were rejected. In a second moment, the researchers evaluated the preliminary results and identified the studies that were present in more than one database, excluding them in order to account for only one copy, and those that had not been identified in the search of both researchers were included or excluded according to compatibility with the research criteria.

In the initial search, using the proposed descriptors, 19 articles were found in the MEDLINE database, 18 in PUBMED, 2 in Cochrane, 1 in SCIELO and 1 in PEDro. Adding the findings of the five proposed databases, 41 articles published between 2012 and 2017 were found. Twenty one copies of duplicated articles in the databases and one in French were excluded. Three studies were excluded due to the impossibility of access to the full text, thus remaining 16 articles. After reading the full text, 6 articles were included in the study because they met the previously defined criteria.

There seem to be agreement among some authors that FM is a risk factor for pain on the pelvic floor when associated with other conditions. However, there is little evidence that women with fibromyalgia have more pelvic floor dysfunctions than women without such diagnosis.

The diversity of evaluation methodology makes it difficult to compare them. Due to the small number of studies found, it was not possible to establish consensus on the guiding question. Thus, it is proposed to conduct a cross-sectional study to evaluate the pelvic floor dysfunction frequency in women with and without FM diagnosis, using the same evaluation methods.

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Marques AP, do Espírito Santo ADS, Berssaneti AA, Matsutani LA, Yuan SLK. A prevalência de fibromialgia: atualização da revisão de literatura. Rev Bras Reumatol. 2017; 57(4): 356-363.
Alonso C, Loevinger BL, Muller D, Coe CL. Menstrual cycle influences on pain and emotion in women with fibromyalgia. J Psychosom Res. 2004; 57(5): 451-458.