Introduction:
Dyspareunia affects a significant proportion of reproductive-age and perimenopausal women. Despite its prevalence and impact on quality of life, it remains underdiagnosed and undertreated. As physiotherapists specializing in pelvic health, we are seeking to collaborate with physicians to improve access to evidence-based care.
Clinical Definition and Subtypes
Dyspareunia can be categorized into superficial and deep types. Superficial dyspareunia is commonly linked to vestibulodynia, vaginismus, or dermatological conditions, whereas deep dyspareunia may be associated with endometriosis, pelvic inflammatory disease, or myofascial pelvic pain (Morin et al., 2017).
Evidence-Based Interventions
A robust body of literature supports pelvic floor physiotherapy as a first-line conservative treatment. Notably:
- Bergeron et al. (2001) conducted a landmark RCT comparing cognitive behavioral therapy, EMG biofeedback, and vestibulectomy in women with provoked vestibulodynia. Biofeedback-guided pelvic floor therapy significantly improved pain scores and patient satisfaction.
- Morin et al. (2017) performed a controlled study that showed a statistically significant reduction in pain and enhancement in sexual function after 10 sessions of targeted physiotherapy in patients with vestibulodynia.
- Zhao et al. (2020) conducted an RCT evaluating the effects of pelvic floor muscle training in women with dyspareunia and reported improved outcomes in muscle coordination, reduced hypertonicity, and pain reduction.
These studies confirm that physiotherapy offers not only symptomatic relief but also long-term improvements in sexual function, partner relationships, and emotional well-being.
Physiotherapy Approach
Our clinical protocol includes:
- Internal and external pelvic floor muscle evaluation
- Myofascial trigger point release
- Manual therapy for pelvic asymmetries
- Graded desensitization and mirror therapy
- Multidisciplinary coordination for psychological support if needed
Our outcomes are systematically tracked using validated tools such as the Female Sexual Function Index (FSFI), Vulvar Pain Functional Questionnaire (V-Q), and pain mapping scores.
Referral Indicators
Consider referring patients with:
- Pain during penetration not explained by infection or anatomical abnormalities
- Diagnosed vestibulodynia, vaginismus, or pelvic floor hypertonicity
- Postpartum or menopausal onset of dyspareunia
- Refractory pain despite pharmacological or surgical intervention
Closing
Pelvic floor physiotherapy is not an adjunct but a central pillar in the comprehensive management of dyspareunia. Interprofessional collaboration ensures a biopsychosocial approach that restores function and quality of life.
We welcome the opportunity to co-manage your patients and provide individualized, evidence-based care.
References:
Bergeron, S., Binik, Y. M., Khalifé, S., Pagidas, K., Glazer, H. I., Meana, M., & Amsel, R. (2001). A randomized comparison of group cognitive–behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia. Pain, 91(3), 297–306. https://doi.org/10.1016/S0304-3959(00)00448-5
Morin, M., Carroll, M. S., Bergeron, S., & Dumoulin, C. (2017). Pelvic floor muscle function in women with and without provoked vestibulodynia: A prospective case-control study. The Journal of Sexual Medicine, 14(11), 1381–1389. https://doi.org/10.1016/j.jsxm.2017.09.002
Zhao, Y., Xie, W., Liu, J., Zhu, Y., Chen, B., & Song, Y. (2020). Effects of pelvic floor muscle training on sexual function and pelvic floor dysfunction in women with dyspareunia: A randomized controlled trial. International Urogynecology Journal, 31(9), 1781–1789. https://doi.org/10.1007/s00192-019-04000-5
