Effect of Vaginal Stretching and Photobiomodulation Therapy on Sexual Function in Women With Pelvic Floor Myofascial Pain - A Randomized Clinical Trial.

BACKGROUND: Spasm or increased tonus of the pelvic floor muscles (PFM) can cause myofascial pain (MP), which may result in painful intercourse and sexual dysfunction. AIM: The effect of vaginal stretching (VS) with photobiomodulation therapy (PBMT) is compared to VS with sham PBMT in overall sexual function, rate and severity of painful intercourse at baseline and after treatment in women with pelvic floor MP. METHODS: A double-blind randomized clinical trial of 103 women with MP: 1 group received 10 sessions of VS with PBMT (4 Joules of near-infrared light-808 nm at 3 points), and the other group received VS with sham PBMT. OUTCOMES: Impact of treatment was measured by the number of women experiencing painful intercourse, Pain severity was measured by Visual Analog Scale and sexual function was assessed by the FSFI questionnaire. Variables were assessed at baseline and after ten sessions in the intervention groups. RESULTS: After treatment, the number of women experiencing painful intercourse was significantly lower in both the VS with PBMT group (90.2-55%, P = .001), and VS with sham PBMT group (86.6-46.2%, P < .001). There was a significant reduction in pain measure by Visual Analog Scale (P < .001, [VS with PBMT group: P = .002; VS with sham PBMT group: P < .001]). There was a significant decrease in the number of participants with sexual dysfunction (FSFI score ≤26.55) after the treatment in the VS with PBMT group (92.2-74.5%, P = .003) and in the VS with sham PBMT group (90.4-76.9%, P = .035). Both groups showed improvement in the FSFI pain domain after treatment (P < .001, [VS with PBMT group: P = .038; VS with sham PBMT group: P = .005]). Only the VS with sham PBMT group had a significant increase in FSFI desire and total score (P < .001) after treatment. CLINICAL IMPLICATIONS: We found that VS associated or not with PBMT may be effective in reducing complaints of painful intercourse, alleviating pain severity, and reducing the number of women with pelvic floor MP suffering from sexual dysfunction. STRENGTHS & LIMITATIONS: Strengths of this study are the randomized design and use of validated questionnaires. Limitation of the study is the lack of a long follow-up period and the lack of a usual care comparison group hampers generalizability of the results. CONCLUSION: VS only and VS with PBMT have short-term efficacy in reducing painful intercourse and reducing a number of women with sexual dysfunction. Frederice CP, de Mira TAA, Machado HC, et al. Effect of Vaginal Stretching and Photobiomodulation Therapy on Sexual Function in Women With Pelvic Floor Myofascial Pain - A Randomized Clinical Trial. J Sex Med 2022;19:98-105.

Tratamento da síndrome da bexiga hiperativa idiopática refratária / Treatment of idiopathic refractory overactive bladder syndrome

A síndrome da bexiga hiperativa é um distúrbio caracterizado pela presença de urgência miccional, podendo ou não haver incontinência urinária associada. Afeta homens e mulheres em iguais proporções, mas tem maior impacto sobre a população feminina, já que a incidência de incontinência é maior. O tratamento de primeira linha consiste em medidas comportamentais, treinamento vesical e fisioterapia, podendo-se associar tratamento farmacológico em casos persistentes. As drogas mais frequentemente utilizadas são os anticolinérgicos, medicações eficazes, porém associadas a efeitos adversos incômodos que frequentemente limitam a aderência. Uma proporção considerável de mulheres não obtém êxito com a combinação de medidas conservadoras e medicações anticolinérgicas, seja por eficácia limitada, seja por efeitos colaterais intoleráveis. Para essa população, modalidades de tratamento de segunda e terceira linha podem trazer alívio sintomático e melhora da qualidade de vida. Além disso, foi recentemente aprovada uma nova classe de drogas para o tratamento da bexiga hiperativa, os agonistas de receptores ?3-adrenérgicos, que prometem eficácia equivalente aos anticolinérgicos sem os efeitos adversos que os limitam...

Overactive bladder syndrome is a condition characterized by urgency, with or without urinary incontinence. It affects men and women equally, but has a greater impact on the female population, given the higher prevalence of urgency-incontinence. First line treatment consists on lifestyle interventions, bladder drills and physical therapy. Pharmacological treatment may be associated in persistent cases. The most commonly used medications are anticholinergics, which are efficacious, but limited by a variety of bothersome adverse effects that impair treatment compliance. A significant proportion of women don?t experience a successful outcome with the combination of conservative measures and treatment with anticholinergics, owing both to limited efficacy and to intolerable adverse effects that lead to treatment discontinuation. For this population, second and third line therapies may provide symptomatic relief, with great improvement in health related quality of life. Also, a new class of drugs, the ?3-adrenergic receptor agonists, has recently been approved for the treatment of overactive bladder, and may provide similar efficacy to currently used anticholinergic drugs without the associated adverse effects...

Fisioterapia na cistite intersticial / Physical therapy on interstitial cystitis

Cistite intersticial (CI) é uma síndrome de etiologia desconhecida, multifatorial, que provoca sintomas no trato urinário inferior como aumento na frequência urinária, urgência miccional, noctúria, acompanhada de dor vesical que frequentemente é aliviada após a micção. A prevalência é maior nas mulheres, que podem apresentar dor em região suprapúbica, perineal, vaginal e, não raramente, dispareunia. A conduta terapêutica é difícil, pela baixa eficácia nos tratamentos oferecidos e pelo alto impacto da doença na qualidade de vida dos pacientes. A fisioterapia surge como um tratamento promissor e de papel fundamental na melhora sintomatológica e redução da disfunção do assoalho pélvico, que comumente acometem os portadores dessa síndrome. Apesar da escassez de trabalhos científicos, principalmente no Brasil, utilizando apenas técnicas fisioterapêuticas, esta revisão discutiu o papel da fisioterapia na CI, enfatizando a terapia manual para o assoalho pélvico (massagem de Thiele) e a terapia comportamental como técnicas mais empregadas para alívio dos sintomas e melhoria na qualidade de vida dos pacientes

Interstitial cystitis (IC) is a mulfactorial syndrome with unknown etiology, which causes symptoms on the lower urinary tract characterized by urinary frequency, urgency, nocturia and bladder pain that diminishes with bladder emptying. The prevalence is significantly higher in women who may have suprapubic, vaginal, perineal pains and dyspareunia. The therapeutic is difficult due to the lower efficiency of the treatments offered and the higher impact in the quality of patients' life. The physical therapy appears tobe a promising treatment and has a fundamental part on the symptoms improvement and reduction of pelvic floor dysfunction. In spite of the shortage of scientific articles using only physiotherapeutic techniques, mainly in Brazil, this review discussed the role of physical therapy on the IC, mainly manual therapy of pelvic floor (Thiele massage) and behavior therapy to relieve the symptoms and improve the quality of life