Physiotherapeutic approach in genito-pelvic pain/penetration disorder
Ana Carla da Silva Nunes, Carla Iasmin Lima Lemos, Nazete dos Santos Araújo, Erica Feio Carneiro Nunes, Cibele Nazaré Câmara Rodrigues
Background: Sexual dysfunctions constitute a public health problem that affects many women during all stages of life, being able to influence physical and mental health, interfering with quality of life. Physical therapy plays a fundamental role in addressing these dysfunctions, with simple and low cost resources, promoting significant results in these cases. Objective: To analyze the effectiveness of a physical therapy protocol on the sexual function of women with genital-pelvic pain/penetration disorder. Methods: Uncontrolled clinical trial, in which participated 15 women with a mean age of 28 ± 4.2 years, who had 16 physical therapy sessions twice a week. The pelvic physiotherapy protocol consisted of the application of electroanalgesia, perineal massage, kinesiotherapy and vaginal dilators. Sexual function was assessed by the Female Sexual Function Index (FSFI) and pain by the Visual Analog Scale (VAS). Results: Given the proposed treatment, the FSFI responded significantly (p=0.0003) with a median improvement that was 19.70 initially and increased to 28.40 later. The VAS also obtained significant improvement (p=0.0003), from the initial median of 8.00 to final 0.00. Conclusion: It is suggested that the physical therapy program has brought significant results in sexual function and pain in women with genital-pelvic pain/penetration disorder.
1. De Carvalho JCGR, Agualusa LM, Moreira LMR, da Costa JCM. Multimodal therapeutic approach of vaginismus: an innovative approach through trigger point infiltration and pulsed radiofrequency of the pudendal nerve. Brazilian Journal of Anesthesiology. 2017; 67(6), 632-636.
2. Lima ACD, Dotto LMG, Mamede MV. Prevalência de disfunção sexual em primigestas, no Município de Rio Branco, Acre, Brasil. Cadernos de Saúde Pública. 2013; 29, 1544-1554.
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. 2013.
4. Baracho E. Fisioterapia aplicada à saude da mulher. 5a ed. Rio de Janeiro: Guanabara Koogan; 2012.
5. Moreno A. Fisioterapia em uroginecologia. 2a ed. São Paulo: Manole; 2004.
6. Antonioli RDS, Simões D. Abordagem fisioterapêutica nas disfunções sexuais femininas. Rev Neurociênc. 2010; 18(2), 267-74.
7. Rosenbaum T. Addressing anxiety in vivo in physiotherapy treatment of women with severe vaginismus: a clinical approach. Journal of sex & marital therapy. 2011; 37(2), 89-93.
8. Martinez JE, Grassi DC, Marques LG. Análise da aplicabilidade de três instrumentos de avaliação de dor em distintas unidades de atendimento: ambulatório, enfermaria e urgência. Rev Bras Reumatol. 2011; 51(4), 299-308.
9. Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. Journal of sex & marital therapy. 2005; 31(1), 1-20.
10. Bo K, Sherburn M. Perspectives-Evaluation of Female Pelvic-Floor Muscle Function and Strength. Physical therapy. 2005; 85(3), 269-282.
11. Thomas HM, Bryce CL, Ness RB, Hess R. Dyspareunia is associated with decreased frequency of intercourse in the menopausal transition. Menopause. 2011; 18(2), 152.
12. Antônio JZ, Silva AD, Costa PPBD, Jung D, Pereira CF, Nunes EFC et al. Função sexual feminina, desgaste emocional por insatisfação sexual e inteligência emocional. Fisioter. Bras. 2016; 17(6): 544-550.
13. Moreira RLBD. Vaginismo. Rev Med Minas Gerais 2013; 23(3): 336-342.
14. Pinheiro M. O casal com vaginismo: um olhar da Gestalt-terapia. Revista IGT na Rede. 2009; 6(10): 91-143.
15. Tomen A, Fracaro G, Nunes EFC, Latorre, GFS. A fisioterapia pélvica no tratamento de mulheres portadoras de vaginismo. Revista de Ciências Médicas. 2016; 24(3): 121-130.
16. Bergeron S, Lord MJ. The integration of pelvi-perineal re-education and cognitive-behavioural therapy in the multidisciplinary treatment of the sexual pain disorders. Sexual and Relationship Therapy. 2003; 18(2), 135-141.
17. Bradley MH, Rawlins A, Brinker CA. Physical therapy treatment of pelvic pain. Physical Medicine and Rehabilitation Clinics. 2017; 28(3), 589-601.
18. Fritz SA. A arte cientifíca da massagem terapêutica. Fundamentos da Massagem Terapêutica. 2a ed. São Paulo: Manole, 2002.
19. Marques A, Ganunny C, Bahamondes L. Use of intravaginal electrical stimulation for the treatment of chronic pelvic pain: a randomized, double-blind, crossover clinical trial. The Journal of reproductive medicine. 2010; 55(1-2), 19-24.
20. Dionisi B, Senatori R. Effect of transcutaneous electrical nerve stimulation on the postpartum dyspareunia treatment. Journal of Obstetrics and Gynaecology Research. 2011; 37(7), 750-753.