7F - To contract or not to contract: Should we use pelvic floor muscle exercises in the treatment of dyspareunia?

Abstract

Introduction and aim of the study/Introduzione e scopo dello studio: Dyspareunia is a common condition of the chronic pelvic pain that affect sexual activity. Within the physiotherapy community and on social media platforms, there is a prevailing belief that relaxation techniques should be prioritized for managing pain associated with dyspareunia, while exercises targeting the pelvic floor muscles (PFM) should be avoided. This research evaluates the existing literature to explore the role of PFM exercises in the treatment of dyspareunia, aiming to discern both the benefits and limitations of this treatment modality. Furthermore, it investigates the rationale behind the recommendation to avoid PFM exercises in cases of dyspareunia.

Materials and methods/Materiali e metodi: Studies included in this review were derived from searches conducted for the purpose of other reviews performed by the authors of this paper conducted in January 2023 and updated in December 2023. Additionally, complementary searches were carried out in PubMed in December 2023, utilizing a combination of keywords associated with dyspareunia, physiotherapy, and pelvic floor exercises. We also searched reference lists of previous review articles in this area.

Results/Risultati: Depending on the specific type of dyspareunia and treatment objectives, PFM exercises may enhance muscle contractility and relaxation, boost strength and endurance, and improve blood flow. These exercises can also improve the condition and elasticity of vaginal mucosal tissue. Furthermore, they may foster greater bodily awareness, motor acuity and sensation. Recent systematic review on PFMT showed effectiveness of PFM exercises, also in terms of improvements in sexual pain.

Interpretation of results/Discussione: The evidence presented indicates that PFM exercises can be effective in treating dyspareunia. Their efficacy is particularly notable when the exercises are performed thoughtfully and under supervision, emphasizing precise contraction, relaxation, and awareness, rather than being carried out automatically without consideration. Therefore, the objective of PFM exercises in addressing pain in dyspareunia may encompass not only traditional strengthening but also fostering awareness, coordination, and enhanced relaxation.

Conclusions/Conclusioni: Based on the presented data, PFM exercises may have multiple applications in the treatment of dyspareunia. It appears essential to consider them as a multifaceted intervention that can be adapted in various forms and for diverse objectives, which extend beyond simple strengthening. PFM exercises have been widely incorporated in research studies, which suggest positive outcomes and the safety of the interventions implemented, contrary to the prevailing beliefs.