The Role of Pelvic Floor Physical Therapy in the Treatment of Pelvic and Genital Pain-Related Sexual Dysfunction
Pelvic pain in women and in men is associated with significant sexual dysfunction. While chronic pain impacts all aspects of functioning, including work, family relationships, and social activities, the most frequent complaint cited by patients with chronic pelvic pain is sexual dysfunction. Factors contributing to sexual dysfunction in patients with chronic pain are multifactorial and contextual, and may be related to comorbidity with depression, use of antidepressant medications, and relationship satisfaction, among many other factors. Physiological correlates may exist, most notably related to pelvic floor dysfunction, which impact both pain and sexual function.
In the absence or presence of organic dysfunction, the musculoskeletal system should be considered, and appropriate treatment provided. Specifically, pelvic floor function should be evaluated, and conditions of abnormal pelvic floor tone should be treated.
The use and efficacy of manual techniques have been reported. Techniques include trigger point massage, myofascial release, connective and scar tissue release, strain-counterstrain, and visceral manipulation. Muscular trigger points produce pain locally and in a referred pattern, and often accompany chronic musculoskeletal disorders. Passive and resisted stretching is designed to normalize postural imbalances, improve blood circulation in the pelvic area, and improve pelvic mobility.
Although several studies have demonstrated that physical therapy is useful in decreasing pain and sexual symptoms in conditions of Chronic Pelvic Pain, continued investigation is necessary in order to examine the role of the pelvic floor in contributing to sexual dysfunction, to measure successful treatment outcomes, and to validate specific physical therapy interventions in contributing to optimal sexual function.
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