Pelvic Health Research Library

Welcome to the Pelvic Health Research Portal, where we have compiled the most important studies in the field of pelvic health as a resource for both practitioners and patients. 

NAVIGATION

Articles in this directory are organized by diagnosis, and you can use the navigation menu to jump directly to the diagnosis you're looking for.  Each article has a brief description along with the full citation.  Click on the full reference at the bottom-right to be linked directly to the article.  

FOUNDER

The Pelvic Health Research Library is founded by Dr. Nicole Cozean and maintained by the Pelvic PT Rising team.  The team also runs a Facebook group for practitioners to share experience, research and knowledge at the Pelvic PT Huddle.

GROWING RESOURCE

This resource is alive and growing; if you have an article you think should be included, please use this form to submit a suggestion with the name of the article and a link to where it can be found online.  

Links to the books here are affiliate links - it doesn't change the price that you pay, but if you do purchase a book from Amazon after clicking the link, we do get a few cents in commission that we use to maintain this free resource.

 
Jerome Weiss.jpg

A holistic view of chronic pelvic pain that can help both patients and practitioners take a broader view of how chronic pain can be treated and managed.

Explain Pain.jpg

David Butler & Lorimer Moseley , 2017

Great explanations for anyone working with chronic pain, offering the latest background on neuroimmune science, conceptual change theory, and educational science

Anatomy Trains.webp

Anatomy book demonstrating how painful problems in one area of the body can be linked to a "silent area" away from the problem, and ultimately giving rise to new treatment strategies.

Pelvic Pain Explained.jpg

A highly detailed explanation of how pelvic pain occurs and how to treat it; an excellent resource for patients and practitioners alike.

The IC Solution.jpg

The IC Solution is a complete guide to interstitial cystitis.  Written for both patients and their practitioners, it lays out all treatment options to create a unique plan for each patient.

A Headache in the Pelvis.jpg

An explanation and treatment plan for men with chronic prostatitis written by leading researchers from Stanford University.

Sex without Pain.png

A patient-friendly self-treatment guide to alleviating painful intercourse,  focuses on both a dilator program for internal work in conjunction with a stretching program.

When Sex Hurts.jpg

A description of the medical causes of painful intercourse from three leaders in the field to understand medical and surgical treatments. 

Heal Pelvic Pain.jpg

A concise and clearly written book, Heal Pelvic Pain gives a straightforward explanation of pelvic pain and a stretching and exercise regimen to improve pelvic health.

INTERSTITIAL CYSTITIS

Controlled, randomized, and multi-site clinical trial of physical therapy for the treatment of interstitial cystitis in both women and men.

FitzGerald, M., R. Anderson, J. Potts, et al. “Randomized Multicenter Feasibility Trial of Myofascial Physical Therapy for Treatment of Urologic Chronic Pelvic Pain Syndrome.” The Journal of Urology 182, no. 2 (June 2009): 570–80.

 

Controlled, randomized, and multi-site clinical trial of physical therapy for the treatment of interstitial cystitis in women.

FitzGerald, M., C. Payne, E. Lukacz, et al. “Randomized Multicenter Clinical Trial of Myofascial Physical Therapy in Women with Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) and Pelvic Floor Tenderness.” The Journal of Urology 187, no. 6 (June 2012): 2113–18.

 

Important study from the RAND Corporation that showed the prevalence of interstitial cystitis was far higher than had previously been assumed, up to 12 million individuals in the United States alone.

Berry, S., M. Elliott, M. Suttorp, et al. “Prevalence of Symptoms of Bladder Pain Syndrome/Interstitial Cystitis Among Adult Females in the United States.” The Journal of Urology 186, no. 2 (August 2011): 540–44.

 

The American Urological Association released guidelines for treatment in 2011, and later updated them in 2014.  They recommend patients proceed through six 'lines' of treatment based on the evidence of efficacy for each treatment.

Hanno, P., D. Burks, J. Clemens, et al. “AUA Guidelines for the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome.” The Journal of Urology 185, no. 6 (June 2011): 2162–70.

 

From the large RAND survey, this study evaluates the prevalence of depressive symptoms and suicidal ideation among patients with interstitial cystitis. 

Hepner, K., K. Watkins, M. Elliott, et al. “Suicidal Ideation among Patients with Bladder Pain Syndrome/Interstitial Cystitis.” Urology 80, no. 2 (August 2012): 280–85.

 

Research describing a validated questionnaire for evaluating interstitial cystitis symptoms.

O’Leary, M. P., G. R. Sant, F. J. Fowler Jr., et al. “The Interstitial Cystitis Symptom Index and Problem Index.” Urology 49, no. 5 Supplement 1 (May 1997): 58–63.

 

From the RAND survey, this study looks at the prevalence of interstitial cystitis in men and how the diagnosis is often confused with chronic prostatitis, concluding that the prevalence of IC in men is far higher than had initially been suspected.

Suskind, A., S. Berry, B. Ewing, et al. “The Prevalence and Overlap of Interstitial Cystitis/Bladder Pain Syndrome and Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Men; Results of the RAND Interstitial Cystitis Epidemiology (RICE) Male Study.” The Journal of Urology 189, no. 1 (January 2013): 141–45.

 

A population-based study of anxiety and depressive symptoms in women with interstitial cystitis.

Watkins, K., N. Eberhart, L. Hilton, et al. “Depressive Disorders and Panic Attacks in Women with Bladder Pain Syndrome/Interstitial Cystitis: A Population-Based Study.” General Hospital Psychiatry 33, no. 2 (March–April 2011): 143–49.

 

Early clinical trial evaluating the efficacy of pelvic floor physical therapy for the treatment of interstitial cystitis.

Weiss, J. M. “Pelvic Floor Myofascial Trigger Points: Manual Therapy for Interstitial Cystitis and the Urgency-Frequency Syndrome.” The Journal of Urology 166, no. 6 (December 2001): 2226–31.

 

An article explaining the history of the nomenclature used to describe interstitial cystitis and how the condition has been defined.

Meijlink, J. “Interstitial Cystitis and the Painful Bladder: A Brief History of Nomenclature, Definitions, and Criteria.” International Journal of Urology 21, Issue Supplement S1 (April 2014): 4–12.

 

Early clinical trial evaluating the efficacy of physical therapy as a treatment for interstitial cystitis.

Oyama, I. A., A. Rejba, J. C. Lukban, et al. “Modified Thiele Massage as Therapeutic Intervention for Female Patients with Interstitial Cystitis and High-Tone Pelvic Floor Dysfunction.” Urology 64, no. 5 (November 2004): 862–65.

 

Effect of food triggers on symptoms of interstitial cystitis.

Shorter B, Lesser M, Moldwin RM et al: Effect of comestibles on symptoms of interstitial cystitis. J Urol 2007; 178: 145

 

Clinical trial of oral amitriptyline for treating IC symptoms. 

Foster, HE et al: Effect of amitriptyline on symptoms in newly diagnosed patients with interstitial cystitis/painful bladder syndrome. J Urol 2010; 183: 1853

 

Controlled, randomized trial of pentosan polysulfate (Elmiron) to treat interstitial cystitis symptoms.

Mulholland SG, Hanno P, Parsons CL et al: Pentosan polysulfate sodium for therapy of interstitial cystitis. A double blind placebo-controlled clinical study. Urology 1990; 35: 552

 

Clinical trial of Lidocaine installation for treatment of interstitial cystitis symptoms.

Nickel JC, Moldwin R, Lee S et al: Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome. BJU Int. 2008; 103: 910

 

Pentosan polysulfate (PPS, Elmiron(R)) was not shown to be significantly more effective than a placebo in a controlled, randomized clinical trial.

Nickel JC, Herschom S, Whitmore KE et al. Pentosan polysulfate sodium for treatment of interstitial cystitis/bladder pain syndrome: insights from a randomized, boule-blind, placebo controlled study. J Urol, 2015 Mar; 193(3):857-62

 

The authors examined the link between urine acidity and interstitial cystitis symptoms, finding that the acidity of urine did not increase symptoms.

Marcu I, Sridhar S, Gavard J, Christin F et al. Effect of Urinary pH on Symptoms of Interstitial Cystitis, IPPS 2017

 

Illness perception plays an important role in dealing with chronic pelvic pain, and negative perception is associated with poor pain modulation and less successful outcomes with manual physical therapy.

Grinberg K, Weissman-Fogel I, Lowenstein L, et al. Negative Illness Perception is Associated with a Pro-Nociceptive Modulation Profile and Augmented Pelvic Pain. IPPS 2017

 

Endometriosis

 

Study reporting on the most common symptoms of endometriosis, including GI symptoms, bloating, irritable bowel syndrome (IBS) and more.

Maroun P, Cooper M, Reid G, Keirse M. Relevance of gastrointestinal symptoms in endometriosis. Australian and New Zealand Journal of Obstetrics and Gynaecology Volume 49, Issue 4

 

Research on how many women with chronic pelvic pain are diagnosed with endometriosis upon laparoscopy.

Jarrell J, Arendt-Nielsen L. Negative Laparoscopy Unveiled. International Pelvic Pain Society (2017)

 

This study demonstrates that the severity of endometriosis does not correlate with the symptoms experienced by patients.

Vercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod. 2007 Jan; 22(1):266-71.

 

The prevalence of endometriosis is approximately one in ten women, but it takes an average of 8-10 years to receive a diagnosis.

Hadfield R, Mardon H, Barlow D, Kennedy S. Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. Human Reproduction, Volume 11, Issue 4, 1 April 1996, Pages 878–880

 

Survey of general practitioners and specialists about their comfort level in diagnosing and treating endometriosis.

Quibel A, Puscasiu L, Marpeau L, Roman H. General practitioners and the challenge of endometriosis screening and care: results of a survey. Gynecol Obstet Fertil. 2013 Jun;41(6):372-80

 

Myofascial pain and dysfunction, along with nervous system upregulation, plays an important role in the symptoms of endometriosis.

Aredo JV, Heyrana KJ, Karp BI, Shah JP, Stratton P. Relating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction. Seminars in reproductive medicine. 2017;35(1):88-97. doi:10.1055/s-0036-1597123.

 

Study examining the need for follow-up surgeries after endometriosis excision, showing 21-37% of women request an additional surgery within two years of the initial procedure.

Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol. 2008 Jun;111(6):1285-92

 

Examining the recurrence rate of endometriosis after hysterectomy.

Rizk B, Fischer AS, Lofty HA et al. Recurrence of endometriosis after hysterectomy. Facts Views Vis Obgyn. 2014; 6(4): 219–227.

 

A systematic review of hormone therapy and medical management of endometriosis.

Becker CM, Gattrell WT, Gude K, Singh SS. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertility and Sterility. 2017;108(1):125-136.

 

Understanding the effects of a gluten-free diet on endometriosis symptoms.

Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi VM. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. 2012 Dec;67(6):499-504.


Efficacy of hormone therapy for the treatment of endometriosis.

Weisberg E, Fraser IS. Contraception and endometriosis: challenges, efficacy, and therapeutic importance. Open Access Journal of Contraception.

Endometriosis pain and symptoms are related to myofascial trigger points in the abdomen (found in 94% of women) and the pelvic floor (61% of women).

Stratton P, Khachikyan I, Sinaii N, Ortiz R, Shah J. Association of Chronic Pelvic Pain and Endometriosis With Signs of Sensitization and Myofascial Pain. Obstet Gynecol. 2015 March ; 125(3): 719–728

 

Clinical trial assessing the efficacy of yoga in the treatment of endometriosis symptoms.

Gonçalves AV, Barros NF, Bahamondes L. The Practice of Hatha Yoga for the Treatment of Pain Associated with Endometriosis. J Altern Complement Med. 2017 Jan;23(1):45-52.

 

Evaluating the combination of stress reduction and physical therapy in the management of endometriosis symptoms.

Friggi Sebe Petrelluzzi K, Garcia MC, Petta CA, Ribeiro DA, de Oliveira Monteiro NR, Céspedes IC, Spadari RC. Physical therapy and psychological intervention normalize cortisol levels and improve vitality in women with endometriosis. J Psychosom Obstet Gynaecol. 2012 Dec;33(4):191-8. doi: 10.3109/0167482X.2012.729625. Epub 2012 Oct 25.

 

Assessment of the efficacy of acupuncture in treating the symptoms of endometriosis.

Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS One. 2017 Oct 27;12(10) 2017.

Both physical therapy and hysterectomy significantly reduce reports of chronic pain in patients with endometriosis.

Martin, C., Johnson, E., Wechter, M., Leserman, J. and Zolnoun, D. (2011). Catastrophizing: a predictor of persistent pain among women with endometriosis at 1 year. Human Reproduction, 26(11), pp.3078-3084.

 

Pregnancy & Post-Natal

Pelvic floor training during pregnancy significantly reduces the risk of post-natal incontinence.

Mørkved, S., Bø, K., Schei, B., & Salvesen, K. Å. (2003). Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstetrics & Gynecology, 101(2), 313-319

 

Pelvic floor training during pregnancy significantly reduced post-natal incontinence by more than 40% in mothers.

Reilly, E. T. C., Freeman, R. M., Waterfield, M. R., Waterfield, A. E., Steggles, P., & Pedlar, F. (2002). Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. BJOG: An International Journal of Obstetrics & Gynaecology, 109(1), 68-76

 

Pelvic floor exercises during pregnancy reduce the risk of incontinence both during the third trimester and after birth.

Mørkved, S., Bø, K., Schei, B., & Salvesen, K. Å. (2003). Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstetrics & Gynecology, 101(2), 313-319

 

Length of the second stage of labor was reduced by pelvic floor muscle training during pregnancy.

Salvesen, K. Å., & Mørkved, S. (2004). Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ: British Medical Journal, 329(7462), 378

 

Women who did not receive pelvic floor muscle training during pregnancy were nearly twice as likely to have post-natal incontinence.

Mørkved, S., & Bø, K. (2000). Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one?year follow up. BJOG: An International Journal of Obstetrics & Gynaecology, 107(8), 1022-1028

 

Prevalence of different kinds of major pelvic floor dysfunction in women (46.7%) and men (11.1%) in a cross-sectional study.

MacLennan, A. H., Taylor, A. W., Wilson, D. H., & Wilson, D. (2000). The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 107(12), 1460-1470

 

Prevalence of post-natal pelvic floor dysfunction, with no difference in symptoms seen between C-section and vaginal delivery

Lukacz, E. S., Lawrence, J. M., Contreras, R., Nager, C. W., & Luber, K. M. (2006). Parity, mode of delivery, and pelvic floor disorders. Obstetrics & Gynecology, 107(6), 1253-1260

 

The authors examine the gait of pregnant women with and without pelvic pain, finding that pelvic pain was associated with increased pelvic rotation and pelvic asymmetry. 

Gonen AB, Demir E, Sakinci M et al. Gait Parameters in Pregnant Women with and Without Pelvic Pain. IPPS 2017

 

Determining the prevalence and risk factors for diastasis recti following childbirth.

Sperstad JB, Tennfjord MK, Hilde G, Ellstrome-Engh M, Bo K. Diastasis Recti Abdominus During Pregnancy and 12 Months after Childbirth: Prevalence, Risk Factors, and Report of Lumbopelvic Pain. BMJ Sports Medicine 50(17), 2016

 

Determining the prevalence of diastasis recti following childbirth.

Demartini E, Deon K, Goncalves de Jesus Fonseca E, Portela B. Diastasis of the Rectus Abdominis Muscle Prevalence in Postpartum. Fisioter. mov 29 (2), 2016

 

Women with sexual dysfunction prior to pregnancy continued to experience it through pregnancy and into the postpartum period, but there was no correlation between sexual dysfunction occurring in pregnancy and post--natal symptoms.

Yildiz H, The Relationship Between Prepregnancy Sexuality and Sexual Function During Pregnancy and the Postpartum Period: A Prospective Study. Journal of Sex & Marital Therapy 2015. 41(1)

 

At 10 months postpartum, 28% of women with C-section deliveries and 46% of women with vaginal deliveries reported dyspareunia, and both caesarean and perineal scars were associated with sexual dysfunction.

Lal M, Pattison HM, Allan TF, Callender R. Does Post-Caesarean Dyspareunia Reflect Sexual Malfunction, Pelvic Floor and Perineal Dysfunction? Journal of Obstetrics & Gynaecology 2011. 31(7)

 

Mind-Body Connection

In a review of 23 studies, mindfulness practice was found to reduce emotional exhaustion, stress, psychological distress, depression, anxiety, and occupational stress.  Further improvements were noted in personal accomplishment, self-compassion, quality of sleep, and relaxation.

Janssen, M., Heerkens, Y., Kuijer, W.,… Engels, J. (2018). Effects of mindfulness-based stress reduction on employees’ mental health: A systematic review. PLoS ONE, 13, e0191332.

 

Evaluating the ability of mindfulness meditation to reduce pain.

Zeidan, F., J. Grant, C. Brown, et al. “Mindfulness Meditation-Related Pain Relief: Evidence for Unique Brain Mechanisms in the Regulation of Pain.” Neuroscience Letters 520, no. 2 (June 2012):165–73.

 

Long-term mindfulness practice has been shown to improve cognitive function, but this study demonstrates that 4 days of meditation training was able to reduce fatigue, anxiety, and improve working memory and the ability to sustain attention.

Zeidan, F., et al. Mindfulness meditation improves cognition: Evidence of brief mental training. Consciousness and Cognition (2010), doi:10.1016/j.concog.2010.03.014

 

Review article examining the evidence of mindfulness to improve the immune system, showing some evidence of changes in specific inflammation markers and immunity.

Black, D. S. Slavich, G. M. (2016). Mindfulness meditation and the immune system: A systematic review of randomized controlled trials. Annals of the New York Academy of Sciences, 1373, 13-24.

 

Review article concluding that mindfulness practice is beneficial in treating anxiety and depression, even without the benefit of a larger therapeutic framework.

Blanck, P., Perleth, S., Heidenreich, T.,… Mander, J. (2018). Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis. Behaviour Research and Therapy, 102, 25-35.

 

A research review concluding that mindfulness practice has the ability to promote weight loss and reduce obesity-related eating behaviors.

Carrière, K., Khoury, B., Günak, M. M., Knäuper, B. (2017). Mindfulness-based interventions for weight loss: A systematic review and meta-analysis. Obesity Reviews, 19, 164-77.

 

In a review of more than twenty studies, researchers concluded that eight different brain regions were consistently altered in those who practiced meditation.

Fox, K. C., Nijeboer, S., Dixon, M. L.,… Christoff, K. (2014). Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neuroscience and Biobehavioral Reviews, 43, 48-73.

 

Research demonstrates that mindfulness practice is effective in improving anxiety and mood symptoms.

Hofmann, S. G., Sawyer, A. T., Witt, A. A., Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169-83.

 

Mindfulness has been shown to decrease binge eating and emotional eating.

Katterman, S. N., Kleinman, B. M., Hood, M. M.,…Corsica, J. (2014). Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: A systematic review. Eating Behaviors, 15,197-4.

 

In reviewing 209 studies, researchers found mindfulness to be effective in treating a variety of psychological problems, especially anxiety, depression, and stress.

Khoury, B., Lecomte, T., Fortin, G.,… Hofmann, S. G. (2013). Mindfulness-Based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33, 763-71.

 

In a seminal study, researchers demonstrated that people are less happy when their minds are wandering, which occurs nearly half of the time for most people.

Killingsworth, M. A., and D. T. Gilbert. “A Wandering Mind Is an Unhappy Mind.” Science, vol. 330, no. 6006, 2010, pp. 932–932., doi:10.1126/science.1192439.

 

A review article concluding that mindfulness is a promising treatment for substance abuse.

Li, W., Howard, M. O., Garland, E. L.,… Lazar, M. (2017). Mindfulness treatment for substance misuse: A systematic review and meta-analysis. Journal of Substance Abuse Treatment, 75, 62-96.

 

Research has demonstrated that mindfulness practice may be able to decrease implicit race and age bias.

Lueke, A., & Gibson, B. (2015). Mindfulness Meditation Reduces Implicit Age and Race Bias: The Role of Reduced Automaticity of Responding. Social Psychological and Personality Science, 6(3), 284–291. https://doi.org/10.1177/1948550614559651

 

Mindfulness interventions were shown to decrease the intensity of pain for chronic pain patients over 16 different studies.

Reiner, K., Tibi, L., Lipsitz, J. D. (2013). Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Medicine, 14, 230-42.

 

Mindfulness is shown in this study to reduce the physical markers of stress within the body, including blood pressure, heart rate, cortisol levels, and inflammation markers.

Pascoe, M. C., Thompson, D. R., Jenkins, Z. M., Ski, C. F. (2017). Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis. Journal of Psychiatric Research, 95, 156-78.

 

Almost 90% of studies reported improvement of negative eating behaviors with mindfulness interventions.

O’Reilly, G. A., Cook, L., Spruijt-Metz, D., Black, D. S. (2014). Mindfulness-based interventions for obesity-related eating behaviours: A literature review. Obesity Reviews, 15, 453-61.

 

Cognitive-behavioral therapy (CBT) compared with traditional psychotherapy in the reduction of pelvic pain.

Masheb, R., R. Kerns, C. Lozano, et al. “A Randomized Clinical Trial for Women with Vulvodynia: Cognitive-Behavioral Therapy vs. Supportive Psychotherapy.” Pain 141, nos. 1–2 (January 2009): 31–40.

 

Patients with chronic pelvic pain saw an increase in gray matter density in areas of the brain associated with pain processing, mood, and motor-sensory function.

Gupta A, Rapkin A, Bhatt R et al. Gray Matter Density is Altered in Females with Provoked Vestibulodynia

 

Mindfulness has shown benefits in reducing symptoms of functional gastrointestinal disorders in a review of seven studies

Aucoin, M., Lalonde-Parsi, M. J., Cooley, K. (2014). Mindfulness-Based therapies in the treatment of functional gastrointestinal disorders: A meta-analysis. Evidence-Based Complementary and Alternative Medicine, 140724.

 

Painful Intercourse

A 2015 paper summarizing new standards for vulvar pain terminology.

Bornstein J, Goldstein A, Stockdale C et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. J Lower Gen Tract Dis 2016; 20:126-130

 

Using imaging techniques, the authors demonstrated that women with provoked vestibulodynia have increased pelvic floor muscle tone and decreased muscle strength.

Morin M, Bergeron S, Khalife S, et al. Morphometry of the Pelvic Floor Muscles in Women With and Without Provoked Vestibulodynia Using 4D Ultrasound. J Sex Med 2014; 11:776-785

 

Women with vulvar vestibulitis syndrome demonstrated significantly more vaginal hypertonicity, lack of muscle strength, and restriction of the vaginal opening.  Pelvic floor physical therapists were consistently able to diagnose pelvic floor dysfunction in this patient population.

Reissing ED, Brown C, Lord MJ, Binik YM, Khalife S. Pelvic Floor Muscle Functioning in Women with Vulvar Vestibulitis Syndrome. J. Psychosom Obstet Gynaecol. 2005 26(2): 107-13

 

An early study in the prevalence of dyspareunia, finding that 61% of women reported experiencing painful intercourse at some point in their lives, with 16% of women experiencing it for their entire adult life.

Glatt AE, Zinner SH, McCormack WM. The Prevalence of Dyspareunia. Obstet Gynecol 1990 75(3:1) 433-6

 

Review article on the evaluation, causes, and treatment for dyspareunia.

Steege J, Zolnoun D. Evaluation and Treatment of Dyspareunia. Obstetrics & Gynecology, 2009. 113(5)

 

The Female Sexual Function Index (FSFI) is validated, self-reporting questionnaire on sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain.

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. Journal of Sex & Marital Therapy. 2011, 26(2)

 

Dyspareunia and sexual dysfunction are common during the third trimester of pregnancy and postpartum, with more than half of women reporting postpartum painful intercourse.

Lagaert L, Weyers S, Van Kerrebroeck H, Elaut E. Postpartum Dyspareunia and Sexual Functioning: A Prospective Cohort Study. European Journal of Contraception & Reproductive Health Care. 2017 22(3)

 

Dyspareunia and sexual dysfunction are common during the third trimester of pregnancy and postpartum, with more than half of women reporting postpartum painful intercourse.

Copy Of -Lagaert L, Weyers S, Van Kerrebroeck H, Elaut E. Postpartum Dyspareunia and Sexual Functioning: A Prospective Cohort Study. European Journal of Contraception & Reproductive Health Care. 2017 22(3)

 

Urinary Symptoms

 

Pelvic floor muscle training and bladder training shown to be just as effective as oral medication in treatment of urinary incontinence.

Azuri, J., Kafri, R., Ziv-Baran, T. and Stav, K. (2016). Outcomes of different protocols of pelvic floor physical therapy and anti-cholinergics in women with wet over-active bladder: A 4-year follow-up. Neurourology and Urodynamics, 36(3), pp.755-758.

 

Physical therapy was shown to be an effective treatment for overactive bladder, with 85% of patients who received myofascial release reporting symptom improvement.  This was significantly higher than patients who received only strength training (26% reported improvement).

Wolff B, Joyce C, McAlamen L et al. Effectiveness of Pelvic Floor Myofascial Release for Overactive Bladder (OAB)

 

A systematic review of pelvic floor muscle training for the treatment of stress urinary incontinence.  Women who received PFMT were 17 times more likely to report an improvement or cure of their symptoms as compared to untreated controls.

Dumoulin C, Hay-Smith EJ, Mac Habee-Seguin G, Pelvic Floor Muscle Training versus No Treatment, or Inactive Control Treatments, for Urinary Incontinence in Women. Cochrane Database Syst Rev, 2014 14:5

 

Pelvic floor muscle training effective reduced overactive bladder symptoms in men and women, including urgency, frequency, and nocturia.  

Burgio, K. (2013). Update on Behavioral and Physical Therapies for Incontinence and Overactive Bladder: The Role of Pelvic Floor Muscle Training. Current Urology Reports, 14(5), pp.457-464.

 

Literary review of outcomes for pelvic floor disorders treated with pelvic floor muscular training, biofeedback, behavioral training, e-stim, acupunture and cognitive behavioral interventions.

Arnouk A, De E, Rehfuss A, Cappadocia C, Dickson S, Lian F. Physical, Complementary, and Alternative Medicine in the Treatment of Pelvic Floor Disorders. Curr Urol Rep. 2017;18(6).

 

Group classes teaching participants to perform Kegels during activities that increase intra-abdominal pressure showed no statistically significant difference when compared to a control group in women with incontinence.

de Andrade R, Bø K, Antonio F et al. An education program about pelvic floor muscles improved women’s knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial. J Physiother. 2018;64(2):91-96.

 

Adding targeted Pilates classes to physical therapy improved quality of life and outcomes for women with urinary incontinence.

Lausen A, Marsland L, Head S, Jackson J, Lausen B. Modified Pilates as an adjunct to standard physiotherapy care for urinary incontinence: a mixed methods pilot for a randomised controlled trial. BMC Womens Health. 2018;18(1). doi:10.1186/s12905-017-0503-y.

 

Patients who presented with pelvic floor symptoms of dysuria, urinary urgency/frequency, and pelvic pain also had a higher risk of myofascial pain syndrome.  Only 31% of patients presenting with these symptoms were diagnosed with a urinary tract infection.

Wolf B, Joyce C, Brincat C, Muller E, Fitzergerald C. Myofascial Pain in Patients with Symptoms of Urinary Tract Infection. IPPS, 2017

 

Pelvic Floor Physical Therapy

The authors report on a controlled clinical trial for intravaginal e-stimulation, which was not more effective than the sham procedure in pain, quality of life, sexual function, or pelvic floor symptoms.

Magelky E, Fitzgerald ES, Unger C, Uy-Kroh MJ. The Inspire Trial: A Randomized Controlled Trial of Intravaginal Electrical Stimulation for Chronic Pelvic Pain

 

Physical therapy was found to be more efficacious than lidocaine for reducing pain during intercourse, sexual distress, and sexual dysfunction.  In total, 77% of women in the physical therapy group reporting significant improvement in their symptoms as compared to 38% in the lidocaine group.  

Morin M, Dumoulin C, Bergeron S et al. A Randomized Clinical Trial Evaluating the Efficacy of Multimodal Physical Therapy in Comparison to Overnight Topical Lidocaine in Women with Provoked Vestibulodynia. IPPS 2017

 

Sixty percent of patients with chronic pelvic pain reported a perceived benefit of BOTOX injections to the pelvic floor, while 74% reported a benefit with the combination of BOTOX and pelvic floor physical therapy

Randle E, Howe C, Rattray D et al. Chronic Pelvic Pain and Pelvic Muscle Injections: Our Local Experience

 

The combination of pelvic floor physical therapy and diazepam suppositories resulted in subjective improvement in 96% (25 of 26) women with high-tone pelvic floor and sexual pain.

Rogalski, M.J., Kellogg-Spadt, S., Hoffmann, A.R. et al. Retrospective Chart Review of Vaginal Diazepam Suppository Use in High-Tone Pelvic Floor Dysfunction. Int Urogynecol J (2010) 21: 895

 

A retrospective evaluation of the prevalence of myofascial pelvic pain and the effectiveness of pelvic floor physical therapy in addressing symptoms.  Pain scores significantly improved, proportionally to the number of physical therapy visits, and 63% of patients reported significant pain improvement.

Bedaiwy MA, Patterson B, Mahajan S. Prevalence of Myofascial Chronic Pelvic Pain and the Effectiveness of Pelvic Floor Physical Therapy. The Journal of Reproductive Medicine, 58(11-12): 504-10, 2013

 

Myofascial trigger point release and paradoxical relaxation techniques significantly improved symptoms in 72% of men with chronic pelvic pain.

Anderson R, Wise D, Sawyer T, Chan C. Integration of Myofascial Trigger Point Release and Paradoxical Relaxation Training Treatment of Chronic Pelvic Pain in Men. Journal of Urology, 174(1): 155-160, 2005

 

Pelvic floor physical therapy was considered successful for 77% of women with provoked vestibulodynia, with improvements in sexual function.

Goldfinger C, Pukall C, Gentilcore-Saulnier E, et al. A Prospective Study of Pelvic Floor Physical Therapy: Pain and Psychosexual Outcomes in Provoked Vestibulodynia. Journal of Sexual Medicine 2009;6:1955–1968

 

Pelvic floor physical therapy was considered successful for 77% of women with provoked vestibulodynia, with improvements in sexual function.

Anderson R, Sawyer T, Wise D, Morey A, Nathanson B. Painful Myofascial Trigger Points and Pain Sites in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Journal of Urology 182(6): 2753-8

 

Women with urinary incontinence had a thinner pelvic floor than women without incontinence.  Gains in the size/strength of the pelvic floor muscles from Kegel exercises were not correlated with symptom improvement.

Bernstein IT. The Pelvic Floor Muscles: Muscle Thickness in Healthy and Urinary-Incontinent Women Measured by Perineal Ultrasonography with Reference to the Effect of Pelvic Floor Training. Neurourol Urodyn. 1997; 16(4) 237-75

 

Background information on the short pelvic floor in patients, discussing the syndromes associated with a shortened pelvic floor and effective therapeutic techniques.

FitzGerald MP, Kotarinos R. Rehabilitation of the Short Pelvic Floor. I: Background and Patient Evaluation. Int Urogynecol J (2003) 14:261-268

 

When treated for their chronic pelvic pain, women also experienced a reduction of pain sensitivity in other areas of the body, suggesting nervous system upregulation plays a major role in chronic pelvic pain.

Gurian M, Neto O, Rosa e Silva J, et al. Reduction of Pain Sensitivity is Associated with the Response to Treatment in Women with Chronic Pelvic Pain. Pain Medicine, 2015 16(5), 849-854