This case report aims to explore the effectiveness of a comprehensive pelvic rehabilitation program in alleviating symptoms of genitourinary syndrome of menopause (GSM) in a breast cancer survivor. We hypothesize that a non-hormonal, multidisciplinary pelvic rehabilitation approach—including pelvic floor muscle training, biofeedback, manual therapy, and targeted home exercises—can significantly reduce GSM symptoms such as urinary incontinence, vaginal dryness, and dyspareunia. This study seeks to provide preliminary evidence supporting pelvic rehabilitation as a viable conservative management option for GSM in patients with contraindications to hormonal therapy.

Study Design:

Single-subject case report

Descriptive and observational in nature

Pre- and post-intervention assessments to evaluate outcomes

Materials:

Biofeedback equipment for pelvic floor muscle training and electromyography (EMG) readings

International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) for assessing urinary incontinence

Pain scale (0–10) for assessing dyspareunia

Clinical tools for manual muscle testing of pelvic floor strength (e.g., Oxford grading scale)

Methods:

Participant:

A 48-year-old female breast cancer survivor (stage II HER-2 positive), experiencing genitourinary syndrome of menopause (GSM) symptoms: stress urinary incontinence, moderate dyspareunia, and vaginal dryness.

Intervention (Pelvic Rehabilitation Program):

Duration: 3 months

Components:

Pelvic floor muscle training using biofeedback

Manual therapy targeting pelvic floor and associated musculature

Tailored home exercise program focused on pelvic stabilization and improving tissue extensibility

Outcome Measures (Pre- and Post-Intervention):

Pelvic floor strength (Oxford scale, from 3/5 to 4+/5)

Electromyography (EMG) resting tone (reduced from 6.6 µV to 1.3 µV)

ICIQ-UI SF score (improved from 11 to 0)

Dyspareunia (pain rating reduced from 6/10 to 4/10)

Subjective improvement in vaginal dryness

Following a three-month pelvic rehabilitation program, the patient demonstrated significant clinical improvement in genitourinary symptoms:

Pelvic Floor Muscle Strength:
Improved from 3/5 to 4+/5 on manual muscle testing using the Oxford grading scale.

Electromyography (EMG) Findings:
Resting pelvic floor muscle tone decreased from 6.6 microvolts to 1.3 microvolts, indicating enhanced neuromuscular relaxation and coordination.

Urinary Incontinence:
The patient’s International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) score improved from 11 to 0, indicating complete resolution of stress urinary incontinence (previously occurring 7–8 times weekly).

Dyspareunia:
Pain during intercourse was reduced from 6/10 to 4/10 on a visual analog pain scale, suggesting a moderate reduction in discomfort.

Vaginal Dryness:
Subjectively reported as improved, with the patient noting greater comfort and less irritation during daily activities and sexual activity.

No adverse events were reported throughout the intervention period. These outcomes support the feasibility and potential benefits of non-hormonal pelvic rehabilitation in managing GSM in breast cancer survivors.

The outcomes of this case suggest that a structured pelvic rehabilitation program can significantly alleviate genitourinary syndrome of menopause (GSM) symptoms in breast cancer survivors, even in the absence of hormonal therapy. The marked improvement in pelvic floor muscle strength and neuromuscular coordination, as evidenced by EMG readings, likely contributed to the complete resolution of urinary incontinence. Additionally, reductions in dyspareunia and vaginal dryness point to enhanced pelvic floor tissue extensibility and improved local circulation, possibly facilitated by manual therapy and targeted exercises.

The patient's response highlights the potential of non-invasive, conservative management approaches for GSM, especially in populations contraindicated for estrogen-based treatments. These findings emphasize the importance of including pelvic rehabilitation in survivorship care plans, offering a safe and effective alternative to pharmacological interventions.

This case demonstrates that a multidisciplinary pelvic rehabilitation program can be an effective non-hormonal intervention for managing genitourinary syndrome of menopause in breast cancer survivors. The observed improvements in urinary continence, pelvic floor function, and sexual comfort underscore the potential role of conservative rehabilitation in enhancing quality of life for this population.

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