Perineal Massage Improves the Dyspareunia Caused by Tenderness of the Pelvic Floor Muscles

Abstract

Aim To evaluate the long-term effectiveness of perineal Thiele massage in the treatment of women with dyspareunia caused by tenderness of the pelvic floor muscles.

Methods A total of 18 women with diagnoses of dyspareunia caused by tenderness of the pelvic floor muscles were included in the study. The women were divided in two groups: the dyspareunia (D) group – 8 women with dyspareunia caused by tenderness of the pelvic floor muscles; and the chronic pelvic pain group (CPP) group – 10 women with dyspareunia caused by tenderness of the pelvic floor muscles associated with CPP. Each patient filled out the Visual Analogue Scale (VAS), the McGill Pain Index, the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). After an evaluation, the women underwent transvaginal massage using the Thiele technique over a period of 5 minutes, once a week for 4 weeks.

Results All women had significant improvements in their dyspareunia according the VAS and the McGill Pain Index (p < 0,001), but the HADS scores did not show significant differences. Regarding sexual function, the D group showed improvements on all aspects of sexual function, while the CPP group showed differences only in the pain domain.

Conclusion Thiele massage is effective in the treatment of dyspareunia caused by tenderness of the pelvic floor muscles with a long-term pain relief.

Resumo

Objetivo Avaliar a eficácia em longo prazo da massagem perineal de Thiele no tratamento de mulheres com dispareunia provocada pela tensão dos músculos do assoalho pélvico.

Métodos Foram incluídos no estudo dezoito mulheres com diagnóstico de dispareunia provocada pela tensão dos músculos do assoalho pélvico. As mulheres foram divididas em dois grupos: o grupo dispareunia (D) – 8 mulheres com dispareunia causada pela tensão dos músculos do assoalho pélvico; e o grupo de dor pélvica crônica (DPC): 10 mulheres com dispareunia causada pela tensão dos músculos do assoalho pélvico associados à DPC. Cada paciente preencheu Escala Visual Analógica (EVA), Índice de Dor de McGill, Índice de Função Sexual Feminino (IFSF) e Escala Hospitalar de Ansiedade e Depressão (EHAD). Após a avaliação, as mulheres foram submetidas a massagem transvaginal utilizando a técnica de Thiele ao longo de um período de 5 minutos, 1 vez por semana durante 4 semanas.

Resultados Todas as mulheres tiveram melhora significativa da dispareunia de acordo com a EVA e o Índice de Dor de McGill (p < 0,001), mas na pontuação do EHAD não mostraram diferenças significativas. Em relação à função sexual, o grupo D apresentou melhora de todos os aspectos da função sexual, enquanto o grupo DPC mostrou diferenças apenas no domínio dor.

Conclusão A massagem perineal de Thiele é eficaz no tratamento da dispareunia causada pela tensão dos músculos do assoalho pélvico, com alívio da dor a longo prazo.

Keywords

dyspareunia - physical therapy - pelvic pain - pelvic floor - women's health

Palavras chaves

dispareunia - fisioterapia - dor pélvica - assoalho pélvico - saúde da mulher

• References

• 1 Pasqualotto EB, Pasqualotto FF, Sobreiro BP, Lucon AM. Female sexual dysfunction: the important points to remember. Clinics (Sao Paulo) 2005; 60 (01) 51-60
• 2 Messelink B, Benson T, Berghmans B. , et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn 2005; 24 (04) 374-380
• 3 Lara LA, Rosa e Silva AC, Romão AP, Junqueira FR. [The assessment and management of female sexual dysfunction]. Rev Bras Ginecol Obstet 2008; 30 (06) 312-321
• 4 Campbell F, Collett BJ. Chronic pelvic pain. Br J Anaesth 1994; 73 (05) 571-573
• 5 Grace V, Zondervan K. Chronic pelvic pain in women in New Zealand: comparative well-being, comorbidity, and impact on work and other activities. Health Care Women Int 2006; 27 (07) 585-599
• 6 Tu FF, As-Sanie S, Steege JF. Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic. J Reprod Med 2006; 51 (03) 185-189
• 7 Revicky V, Mukhopadhyay S, Morris E. Dyspareunia in gynaecological practice. Obstetrics, Gynaecol Reprod Med 2012; 22 (06) 148-154
• 8 Wolpe RE, Toriy AM, Silva FP, Zomkowski K, Sperandio FF. Atuação da fisioterapia nas disfunções sexuais femininas: uma revisão sistemática. Acta Fisiátr 2015; 22 (02) 87-92
• 9 Montenegro ML, Mateus-Vasconcelos EC, Candido dos Reis FJ, Rosa e Silva JC, Nogueira AA, Poli Neto OB. Thiele massage as a therapeutic option for women with chronic pelvic pain caused by tenderness of pelvic floor muscles. J Eval Clin Pract 2010; 16 (05) 981-982
• 10 Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int 1985; 5 (04) 145-148
• 11 Melzack R. The McGill pain questionnaire: from description to measurement. Anesthesiology 2005; 103 (01) 199-202
• 12 Pacagnella RdeC, Martinez EZ, Vieira EM. [Construct validity of a Portuguese version of the Female Sexual Function Index]. Cad Saude Publica 2009; 25 (11) 2333-2344
• 13 Rosen R, Brown C, Heiman J. , et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000; 26 (02) 191-208
• 14 Botega NJ, Bio MR, Zomignani MA, Garcia Jr C, Pereira WA. [Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD]. Rev Saude Publica 1995; 29 (05) 355-363
• 15 Oyama IA, Rejba A, Lukban JC. , et al. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology 2004; 64 (05) 862-865
• 16 Payne KA, Binik YM, Amsel R, Khalifé S. When sex hurts, anxiety and fear orient attention towards pain. Eur J Pain 2005; 9 (04) 427-436
• 17 Abdo CH, Fleury HJ. Aspectos diagnósticos e terapêuticos das disfunções sexuais femininas. Rev Psiquiatr Clin (Santiago) 2006; 33 (03) 162-167
• 18 Fleury HJ, Abdo CH. Dor genital feminina. Diagn Tratamento 2013; 18 (03) 124-127
• 19 Nogueira AA, Reis FJ, Poli Neto OB. Management of chronic pelvic pain in women. Rev Bras Ginecol Obstet 2006; 28 (12) 733-740
• 20 Verit FF, Verit A, Yeni E. The prevalence of sexual dysfunction and associated risk factors in women with chronic pelvic pain: a cross-sectional study. Arch Gynecol Obstet 2006; 274 (05) 297-302
• 21 Romão AP, Gorayeb R, Romão GS. , et al. Chronic pelvic pain: multifactorial influences. J Eval Clin Pract 2011; 17 (06) 1137-1139
• 22 Rosenbaum TY. Physiotherapy treatment of sexual pain disorders. J Sex Marital Ther 2005; 31 (04) 329-340