Algorithm for diagnosing dyspareunia associated with pelvic floor muscle dysfunction
AbstractDyspareunia is a common symptom in female population, often associated with pelvic floor muscle dysfunction. High prevalence of this nosology explains the importance of highlighting methods of its diagnosis, and when it is combined with pelvic floor muscle dysfunction - importance of complex perineological methods. This will improve diagnostic capabilities, interpretation of the results of clinical and instrumental methods available for use in routine clinical practice.
This approach will make it possible to form a complete concept for diagnosing the considered pathological condition, as well as to evaluate the dynamics of changes in treatment of pelvic floor muscle hyperkinetic dysfunction, which underlies dyspareunia associated with muscle component.
The aim of the study was to analyze and summarize scientific data accumulated to date regarding methods for diagnosing dyspareunia associated with pelvic floor muscle dysfunction.
Material and methods. The analysis of scientific publications in CochraneLibrary, PubMed, Science Direct, ELibrary databases (keywords: dyspareunia, pelvic floor muscle dysfunction, quality of life, electromyography and perineometry) for 2012–2022 was performed.
Results. It has been established that there is still no holistic approach to diagnosis of dyspareunia formed as a result of pelvic floor muscle hyperkinetic dysfunction, and unified diagnostic criteria for verification have not been developed. Obviously, further studies are needed, the results of which will allow creating a unified algorithm for diagnosing this nosology.
Keywords:dyspareunia; pelvic floor muscle dysfunction; hyperkinetic activity; electromyography; perineometry; quality of life
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
Contribution. The authors report that the article complies with the international ICMJE criteria. All authors equally contributed to the preparation of the publication: development of the concept, search and analysis of relevant literature data, writing and making changes, approval of the final version of the article.
For citation: Orazov M.R., Silant’eva E.S., Astafieva E.K. Algorithm for diagnosing dyspareunia associated with pelvic floor muscle dysfunction. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2023; 11. Supplement: 144–50. DOI: https://doi.org/10.33029/2303-9698-2023-11-suppl-144-150 (in Russian)
References
1. Kegel A.H., Powell T.O. The physiologic treatment of urinary stress incontinence. J Urol. 1950; 63 (5): 808–14. DOI: https://doi.org/10.1016/s0022-5347(17)68832-3 PMID: 15422687.
2. Jones E.G. Nonoperative treatment of stress incontinence. Clin Obstet Gynecol. 1963; 6: 220–35. DOI: https://doi.org/10.1097/00003081-196303000-00019 PMID: 13964710.
3. Sorensen J., Bautista K.E., Lamvu G., et al. Evaluation and treatment of female sexual pain: A clinical review. Cureus. 2018; 10 (3): e2379. Epub 2018 Mar 27. DOI: https://doi.org/10.7759/cureus.2379
4. Granot M., Yovell Y., Somer E., et al. Trauma, attachment style, and somatization: a study of women with dyspareunia and women survivors of sexual abuse. BMC Womens Health. 2018; 18 (1): 29. Epub 2018 Jan 30. DOI: https://doi.org/10.1186/s12905-018-0523-2
5. Hagey J.M., Toole J., Branford K., et al. Understanding sexual complaints and history taking: a standardized patient case on dyspareunia for obstetrics and gynecology clerkship students. MedEdPORTAL. 2020; 16: 11001. Epub 2020 Oct 29. DOI: https://doi.org/10.15766/mep_2374-8265.11001
6. Facchin F., Buggio L., Dridi D., et al. The subjective experience of dyspareunia in women with endometriosis: A systematic review with narrative synthesis of qualitative research. Int J Environ Res Public Health. 2021; 18 (22): 12112. Epub 2021 Nov 18. DOI: https://doi.org/10.3390/ijerph182212112
7. Meston C.M. Validation of the Female Sexual Function Index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder. J Sex Marital Ther. 2003; 29 (1): 39–46. DOI: https://doi.org/10.1080/713847100 PMID: 12519665; PMCID: PMC2872178.
8. Neijenhuijs K.I., Hooghiemstra N., Holtmaat K., et al. The Female Sexual Function Index (FSFI): A systematic review of measurement properties. J Sex Med. 2019; 16 (5): 640–60. DOI: https://doi.org/10.1016/j.jsxm.2019.03.001 Epub 2019 Apr 5. PMID: 30956110.
9. Derogatis L.R., Rosen R., Leiblum S., et al. The Female Sexual Distress Scale (FSDS): Initial validation of a standardized scale for assessment of sexually related personal distress in women. J Sex Marital Ther. 2002; 28 (4): 317–30. DOI: https://doi.org/10.1080/00926230290001448 PMID: 12082670.
10. Derogatis L.R., Revicki D.A., Rosen R.C., et al. Psychometric validation of the Female Sexual Distress Scale-Desire/Arousal/Orgasm. J Patient Rep Outcomes. 2021; 5 (1): 100. DOI: https://doi.org/10.1186/s41687-021-00359-1 PMID: 34559353; PMCID: PMC8463644.
11. Klaassen M., Ter Kuile M.M. Development and initial validation of the vaginal penetration cognition questionnaire (VPCQ) in a sample of women with vaginismus and dyspareunia. J Sex Med. 2009; 6 (6): 1617–27. DOI: https://doi.org/10.1111/j.1743-6109.2009.01217.x PMID: 19538428.
12. Majani G., Tiengo M., Giardini A., et al. Relationship between MPQ and VAS in 962 patients. A rationale for their use. Minerva Anestesiol. 2003; 69 (1–2): 67–73. PMID: 12677163.
13. Dubé M.O., Langevin P., Roy J.S. Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: a systematic review. Pain Rep. 2021; 6 (4): e972. DOI: https://doi.org/10.1097/PR9.0000000000000972 PMID: 34963996; PMCID: PMC8701870.
14. Patil S., Daniel G., Vyas R., et al. Neuromuscular treatment approach for women with chronic pelvic pain syndrome improving pelvic pain and functionality. Neurourol Urodyn. 2022; 41 (1): 220–8. DOI: https://doi.org/10.1002/nau.24799 Epub 2021 Sep 16. PMID: 34529875.
15. Osman A., Wong J.L., Bagge C.L., et al. The Depression Anxiety Stress Scales-21 (DASS-21): Further examination of dimensions, scale reliability, and correlates. J Clin Psychol. 2012; 68 (12): 1322–38. DOI: https://doi.org/10.1002/jclp.21908 Epub 2012 Aug 28. PMID: 22930477.
16. Peters L., Peters A., Andreopoulos E., et al. Comparison of DASS-21, PHQ-8, and GAD-7 in a virtual behavioral health care setting. Heliyon. 2021; 7 (3): e06473. DOI: https://doi.org/10.1016/j.heliyon.2021.e06473 PMID: 33817367; PMCID: PMC8010403.
17. Brazier J.E., Harper R., Jones N.M., et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992; 305 (6846): 160–4. DOI: https://doi.org/10.1136/bmj.305.6846.160 PMID: 1285753; PMCID: PMC1883187.
18. Vandyken B., Keizer A., Vandyken C., et al. Pelvic floor muscle tenderness on digital palpation among women: convergent validity with central sensitization. Braz J Phys Ther. 2021; 25 (3): 256–61. DOI: https://doi.org/10.1016/j.bjpt.2020.05.013 Epub 2020 Jun 6. PMID: 32563663; PMCID: PMC8134766.
19. Bo K., Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005; 85 (3): 269–82. PMID: 15733051.
20. Harm-Ernandes I., Boyle V., Hartmann D., et al. Assessment of the pelvic floor and associated musculoskeletal system: Guide for medical practitioners. Female Pelvic Med Reconstr Surg. 2021; 27 (12): 711–8. DOI: https://doi.org/10.1097/SPV.0000000000001121 PMID: 34807882.
21. Meister M.R., Sutcliffe S., Ghetti C., et al. Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain. Am J Obstet Gynecol. 2019; 220 (3): 255.e1–9. DOI: https://doi.org/10.1016/j.ajog.2018.11.1106
22. Chevalier F., Fernandez-Lao C., Cuesta-Vargas A.I. Normal reference values of strength in pelvic floor muscle of women: a descriptive and inferential study. BMC Womens Health. 2014; 14: 143. Epub 2014 Nov 25. DOI: https://doi.org/10.1186/s12905-014-0143-4
23. Angelo P.H., Varella L.R.D., de Oliveira M.C.E., et al. A manometry classification to assess pelvic floor muscle function in women. PLoS One. 2017; 12 (10): e0187045. Epub 2017 Oct 30. DOI: https://doi.org/10.1371/journal.pone.0187045
24. Frawley H., Shelly B., Morin M., et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn. 2021; 40 (5): 1217–60. DOI: https://doi.org/10.1002/nau.24658 Epub 2021 Apr 12. PMID: 33844342.
25. Barber M.D., Whiteside J.L., Walters D.M. Neurophysiologic Testing of the Pelvic Floor. In: The Global Library of Women’s Medicine. January 2009. DOI: https://doi.org/10.3843/GLOWM.10057
26. Artemova N.M., Vezenova I.V., Sokolov A.V. Stimulation electromyography: a textbook for physicians. Ryazan’: RIO RyazGMU, 2013: 12. (in Russian) [Артемова Н.М., Везенова И.В., Соколов А.В Стимуляционная электромиография : учебное пособие для врачей. Рязань : РИО РязГМУ, 2013. С. 12.]
27. Lak R., Amiri M., Abdollahi I., et al. Research paper: Effect of strength and endurance training on the pelvic floor muscles in women with stress urinary incontinence. J Rehabil. 2016; 17 (3): 222–31. URL: http://rehabilitationj.uswr.ac.ir/article-1-2079-en.html
28. Koenig I., Luginbuehl H., Radlinger L. Reliability of pelvic floor muscle electromyography tested on healthy women and women with pelvic floor muscle dysfunction. Ann Phys Rehabil Med. 2017; 60 (6): 382–6. DOI: https://doi.org/10.1016/j.rehab.2017.04.002
29. McLean L., Brooks K. What does electromyography tell us about dyspareunia? Sex Med Rev. 2017; 5 (3): 282–94. DOI: https://doi.org/10.1016/j.sxmr.2017.02.001 Epub 2017 Mar 18. PMID: 28330675.
30. Morrissey D., El-Khawand D., Ginzburg N., et al. Botulinum toxin A injections into pelvic floor muscles under electromyographic guidance for women with refractory high-tone pelvic floor dysfunction: A 6-month prospective pilot study. Female Pelvic Med Reconstr Surg. 2015; 21 (5): 277–82. DOI: https://doi.org/10.1097/SPV.0000000000000177 PMID: 25900057.
31. Dias N., Zhang C., Smith C.P., et al. High-density surface electromyographic assessment of pelvic floor hypertonicity in IC/BPS patients: a pilot study. Int Urogynecol J. 2021; 32 (5): 1221–8. DOI: https://doi.org/10.1007/s00192-020-04467-2
32. Dietz H.P. Pelvic floor ultrasound: a review. Am J Obstet Gynecol. 2010; 202 (4): 321–34. DOI: https://doi.org/10.1016/j.ajog.2009.08.018 PMID: 20350640.
33. Turo D., Otto P., Shah J.P., et al. Ultrasonic tissue characterization of the upper trapezius muscle in patients with myofascial pain syndrome. Annu Int Conf IEEE Eng Med Biol Soc. 2012; 2012: 4386–9. DOI: https://doi.org/10.1109/EMBC.2012.6346938
34. Ballyns J.J., Turo D., Otto P., et al. Office-based elastographic technique for quantifying mechanical properties of skeletal muscle. J Ultrasound Med. 2012; 31 (8): 1209–19. DOI: https://doi.org/10.7863/jum.2012.31.8.1209
35. Sikdar S., Shah J.P., Gebreab T., et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. 2009; 90 (11): 1829–38. DOI: https://doi.org/10.1016/j.apmr.2009.04.015 PMID: 19887205; PMCID: PMC2774893.
36. Yang A., Mostwin J.L., Rosenshein N.B., et al. Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology. 1991; 179 (1): 25–33. DOI: https://doi.org/10.1148/radiology.179.1.2006286 PMID: 2006286.
37. Evans V., Behr M., Gangwar A., et al. Potential role of MRI imaging for myofascial pain: A scoping review for the clinicians and theoretical considerations. J Pain Res. 2021; 14: 1505–14. Epub 2021 May 27. DOI: https://doi.org/10.2147/JPR.S302683
38. da Silva H.K.V., Oliveira M.C.E., Silva-Filho E. et al. Evaluation of the female pelvic floor with infrared thermography: a cross sectional study. Braz J Phys Ther. 2022; 26 (1): 100390. DOI: https://doi.org/10.1016/j.bjpt.2022.100390 Epub 2022 Jan 26. PMID: 35104749; PMCID: PMC8803949.
39. Lubkowska A., Pluta W. Infrared thermography as a non-invasive tool in musculoskeletal disease rehabilitation – the control variables in applicability: A systematic review. Appl. Sci. 2022; 12: 4302. DOI: https://doi.org/10.3390/app12094302
40. Moreira D.G., Costello J.T., Brito C.J., et al. Thermographic imaging in sports and exercise medicine: A Delphi study and consensus statement on the measurement of human skin temperature. J Therm Biol. 2017; 69: 155–62.
41. Sikdar S., Shah J.P., Gebreab T., et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. 2009; 90 (11): 1829–38. DOI: https://doi.org/10.1016/j.apmr.2009.04.015 PMID: 19887205; PMCID: PMC2774893.
42. Rosendal L., Kristiansen J., Gerdle B., et al. Increased levels of interstitial potassium but normal levels of muscle IL-6 and LDH in patients with trapezius myalgia. Pain. 2005; 119 (1–3): 201–9. DOI: https://doi.org/10.1016/j.pain.2005.09.026 Epub 2005 Nov 16. PMID: 16297553.
43. Farhana A., Lappin S.L. Biochemistry, Lactate Dehydrogenase [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jan.
44. Li L.H., Huang Q.M., Barbero M., et al. Quantitative proteomics analysis to identify biomarkers of chronic myofascial pain and therapeutic targets of dry needling in a rat model of myofascial trigger points. J Pain Res. 2019; 12: 283–98. Epub 2019 Jan 7. DOI: https://doi.org/10.2147/JPR.S185916
45. Shakouri S.K., Dolatkhah N., Omidbakhsh S., et al. Serum inflammatory and oxidative stress biomarkers levels are associated with pain intensity, pressure pain threshold and quality of life in myofascial pain syndrome. BMC Res Notes. 2020; 13: 510. DOI: https://doi.org/10.1186/s13104-020-05352-3
46. Grosman-Rimon L., Parkinson W., Upadhye S., et al. Circulating biomarkers in acute myofascial pain: A case-control study. Medicine (Baltimore). 2016; 95 (37): e4650. DOI: https://doi.org/10.1097/MD.0000000000004650