Exclusive manual perineal rehabilitation with lidocaine 2% gel in the treatment of provoked vestibulodynia: results from a single-arm interventional study.

As of now, there is no adequate therapeutic strategy for provoked vestibulodynia (PVD). Pelvic Floor Muscle Therapy (PFMT) is a widely used technique in general pelvic floor rehabilitation. The objective of this study is to examine the effects of exclusive manual perineal rehabilitation with lidocaine 2% gel on PVD. During the first session, recruited patients (n = 68; mean age 31 ± 8.6; range: 18-52) received a questionnaire (Q1) on general well-being and health, pain of the genital area, sexual function, and symptoms during vaginal penetration. This questionnaire was based on a generalised questionnaire on the quality of life, the Medical Outcomes Study 36-item (SF-36), the Female Sexual Function Index (FSFI), and the Visual Analogue Scale (VAS). A second identical questionnaire with an additional set of open-ended questions concerning the assessment of the treatment was collected after treatment (Q2). A total of 45 questionnaires were completed. Statistical results showed a significant improvement of all items before and after treatment (p < 0.001): perceived general well-being and health, perceived vulvar pain, perceived sexual function, and perceived vaginal penetration. In conclusion, exclusive manual perineal rehabilitation using lidocaine 2% gel seems to be a safe and effective treatment option for vulvodynia in women.

[Validation of a new self-questionnaire to assess sexuality in patients operated on for urinary incontinence or genital prolapse (Pelvi-Perineal Surgery Sexuality Questionnaire - PPSSQ)]. / Validation d'un nouvel auto-questionnaire d'évaluation de la sexualité chez les patientes opérées d'une incontinence urinaire ou d'un prolapsus génital (Pelvi-Perineal Surgery Sexuality Questionnaire ­ PPSSQ).

INTRODUCTION: The main objective of this study was to validate a new questionnaire evaluating sexual health, in a population of sexually active women or not, who have surgery for stress urinary incontinence or pelvic organ prolapse with or without mesh reinforcement. MATERIAL AND METHODS: After the development of a first version of the questionnaire by members from the main French societies involved in the study of women's sexuality, a linguistic validation of the content of the questionnaire was carried out through semi-structured interviews. Then, a psychometric validation was carried out in a prospective multicenter cohort study. The questionnaire was evaluated in terms of acceptability, quality, dimensionality, internal consistency, temporal stability, sensitivity to changes and construction validity. RESULTS: Linguistic validation was carried out in 25 patients. Psychometric validation was carried out in 297 women (291 with available data) operated on for urinary incontinence by midurethral sling (n=79) or for pelvic organ prolapse by the vaginal route with mesh (n=105), without mesh (n=22) or by laparoscopic sacrocolpopexy (n=85) between January 18, 2013 and January 18, 2016. Within the 288/291 women who had filed the question No. 1 allowing to know their sexual "status", 159 (55%) women were sexually active and 129 (45%) women were not sexually active before surgery. Within the 288 women, 165 had completed the questionnaire preoperatively and at 12 months and 111 had completed the questionnaire at 12 months and 12 months+1 week. The questionnaire was well accepted by the women and of good quality. All the questions were kept, but a change in the order and numbering of the questions had to be made. Two clinically relevant dimensions were identified in this analysis: a "sexual health" dimension comprising 5 questions and a "discomfort and pain" dimension comprising 3 questions. The overall questionnaire and both dimensions had good reliability and moderate to excellent temporal stability. A statistically significant association was demonstrated between question 15 and the improvement reported by PGI-I and the anatomical success rate on POP-Q classification. A strong correlation was found between the "sexual health" score and the total FSFI score. CONCLUSION: The Pelvi-Perineal Surgery Sexuality Questionnaire (PPSSQ) is a 13-question self-questionnaire validated in a population of sexually active women or not, operated on for stress urinary incontinence or pelvic organ prolapse by laparoscopy or vaginal surgery, with or without mesh. LEVEL OF EVIDENCE: 4.

[Rehabilitation during pregnancy and in the postpartum]. / La rééducation pendant la grossesse et dans le post-partum.

Pregnancy and labour are notable etiopathogenic factors concerning urinary incontinence and pelvic positional problems. 30 to 40% of women suffer from incontinence during pregnancy and 20% in the post-partum period. While this incontinence regresses spontaneously in 60 to 80% of cases, it nevertheless reflects the existence of pelviperineal problems. Combined with the efforts of everyday life, this trauma finally explains the high incidence of women with urinary problems and pelvic positional difficulties starting from the fourth and fifth decades of life. Perineo-sphincter exercises must be started very early, during the pre-partum phase and always before the start of sports and occupational activities. It involves all the constituents of the lumbo-pelvi-perineal region and in particular perineal tone, muscle power and strength and the quality of sphincter closure during effort. These efforts are themselves studied on the basis of the pressures which they produce. In total, perineal exercises, abdominal exercises and physical activity are not contradictory but, in fact, complementary, such that the management approach is global and adapted to the individual.

[The value and results of perineal-sphincteral rehabilitation in uro-gynecology]. / Intérêts et résultats de la rééducation périnéo-sphinctérienne en urogynécologie.

Urinary incontinence, considered as a taboo for a long time, is an invalidating condition which gives rise to several problems. About one person out of 20 suffers from it, that is, more than 2 million persons in France, half of whom are less than 50 years old. By an anatomophysiological and etiopathogenic review, the authors define the different causes of urinary incontinence in women, as well as other pathologies such as dyspaneuria or changes in the pelvic statics. They define the role, the indications and the limits of perineo-sphincteral re-education, underlining the notions or prevention, particularly in post partum, and that of the complementarity with the various therapeutic approaches.

[Terminal constipation caused by abdominopelvic asynchrony: analysis of etiological, clinical, manometric data and therapeutic results after rehabilitation by biofeedback]. / Constipation terminale par asynchronisme abdomino-pelvien: analyse des données étiologiques, cliniques, manométriques, et des résultats thérapeutiques après rééducation par biofeedback.

The aim of this study was to describe the etiological, clinical, rectoanal manometric findings as well as the results of biofeedback therapy in a series of 65 patients (34 males, 31 females, aged between 5 and 77 years) presenting with severe primary constipation due to pelvic abdominal asynchronism. Pelvic abdominal asynchronism was statistically more frequent in males during childhood and in female patients during adult life (p less than 0.005). This study disclosed a high frequency of psychogenic factors in the onset of pelvic abdominal asynchronism (26 p. 100) as well as a high frequency of soiling (46.2 p. 100) in constipated patients. In 36.2 p. 100 of cases, pelvic abdominal asynchronism was the only abnormality. In contrast, in most of the patients, asynchronism was associated with miscellaneous rectoanal disorders: increased anal closure pressure (43.3 p. 100), decreased anal closure pressure (11.8 p. 100), impaired rectal conscious sensitivity (11.7 p. 100), and increased rectal compliance (31 p. 100). This study demonstrated that when high-fiber diet and laxatives fail, biofeedback therapy is a very interesting alternative, providing 80 p. 100 of good results in selected cases. However, we were unable to find any clinical or manometric parameters predictive of results of treatment. Follow-up studies are needed to determine long-term results of biofeedback training.