Impact of pelvic floor muscle strength on female sexual function: retrospective multicentric cross-sectional study.

INTRODUCTION AND HYPOTHESIS: The female pelvic floor muscles (PFM) play an important role in sexual function. We hypothesize that there is a relation between PFM strength and sexual function in women with and without sexual dysfunction. METHODS: Retrospective multicentric cross-sectional study including women with and without sexual dysfunction [Female Sexual Function Index (FSFI) cutoff point < 26.55], analyzed by age range, considering demographic, clinical, anthropometric and PFM strength [Modified Oxford Scale (MOS)] data. Chi-square, Mann-Whitney test and linear regression (ranks) were used, with 5% significance (SAS 9.4). RESULTS: Out of 1013 medical records, 982 women with an average age of 45.76 (± 15.25) were included in the study. Of these, 679 (69.14%) presented FSFI score < 26.55, while 303 (30.86%) presented FSFI ≥ 26.55. It was identified that the higher scores were among white women, < 45 years old, single, with higher education, family income > 4 minimum wages, body mass index < 25 kg/m2, lower parity, regular physical activity practitioner and higher PFM strength (MOS: 4-5). Desire, arousal, lubrication and orgasm domains were higher among women with MOS 4-5, while satisfaction and pain domains were higher among those with MOS 3-5. CONCLUSION: Demographic, clinical and anthropometric conditions can influence both PFM strength and female sexual function. Our findings demonstrate that women with higher PFM strength present fewer complaints about sexual dysfunction.

Electromyographic pelvic floor activity: Is there impact during the female life cycle?

AIM: To evaluate the pelvic floor muscle (PFM) electromyographic activity in different phases of the female life cycle, correlating electromyographic activity with age, Body Mass Index (BMI), parity as well as the presence and severity of urinary symptoms. METHODS: A clinical, observational, transversal and controlled study was conducted in 384 women: 49 nulliparous, 103 primigravid pregnant, 92 primiparous postpartum (vaginal delivery: n = 43; cesarean section delivery: n = 49), 22 climacteric, 65 postmenopausal, and 53 women identified as being unable to perform voluntary maximum contraction. All subjects were evaluated with digital palpation and PFM surface electromyography (sEMG) and completed the questionnaires: International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ IU-SF) and International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). Spearman's Correlation Coefficient and ANOVA were used to analyze the variables. RESULTS: The nulliparous women had higher PFM electromyographic activity than the other groups. The primigravid pregnant, cesarean section and vaginal delivery groups had higher electromyographic activity than the postmenopausal group. Studying PFM electromyographic activity with the factors evaluated, a negative correlation between age, parity, and the presence and severity of urinary symptoms was observed. There was no correlation between PFM electromyographic activity and BMI. CONCLUSION: Fourteen percent of women participating were not able to perform active contraction of the PFM. PFM electromyographic activity changed during the female life cycle. PFM electromyographic activity correlated inversely with age, parity, and the presence and severity of urinary symptoms.

Is there correlation between electromyography and digital palpation as means of measuring pelvic floor muscle contractility in nulliparous, pregnant, and postpartum women?

AIMS: The continence mechanisms depend on the integrity of the pelvic floor muscles. It is therefore important to find simple, reliable, and safe methods to assess its contractility in a clinical setting. This study aims to investigate if digital palpation of the pelvic floor muscles presents correlation with its electromyographic activity. METHODS: The sample consisted of 307 women with mean age of 23.93 years, including 39 nulliparous, 117 primigravid pregnant, 64 primiparous, in post-vaginal delivery, and 87 primiparous women, in post-cesarean section delivery. The assessment consisted of both digital palpation and surface electromyography. One, and the same, highly skilled and experienced physiotherapist, who was able to classify the different grades of contractility accurately, performed digital palpation using the Modified Oxford Grading Scale. Surface electromyography was performed using an intravaginal probe. For electromyography evaluation, three contractions of 5 sec each were recorded, and an average of three Root Mean squares was considered for analysis. Spearman's Coefficient, Jonckheere-Terpstra Test, Kruskal-Wallis as well as Dunn Test were used for statistical analysis. RESULTS: The strong correlation found between the two methods (P < 0.001) indicates that both digital palpation and electromyography can be used in everyday practice, both for clinical use and scientific research, although both have their specific limitations and requirements to avoid the risk of biases. CONCLUSION: There was a correlation between pelvic floor muscle contractility measured by surface electromyography and by digital palpation. Both methods can be used to validate data in research and clinical setting.

Are transversus abdominis/oblique internal and pelvic floor muscles coactivated during pregnancy and postpartum?

AIM: The aim of this study was to simultaneously evaluate both transversus abdominis/internal oblique (Tra/IO) and pelvic floor muscles (PFM) during isometric exercises in nulliparous, pregnant, and postpartum women. METHODS: The study included 81 women divided into four groups: (G1) nulliparous women without urinary symptoms (n = 20); (G2) primigravid pregnant women with gestational age ≥24 weeks (n = 25); (G3) primiparous postpartum women after vaginal delivery with right mediolateral episiotomy (n = 19); (G4) primiparous postpartum women after cesarean section delivery, with 40 to 60 days of postpartum (n = 17). The assessment consisted of simultaneous surface electromyography (EMGs) of the PFM and Tra/IO, during three isometric maximum voluntary contractions. RESULTS: Only nulliparous women presented significant simultaneous Tra/IO and PFM co-activation when asked to contract PFM (P = 0.0007) or Tra/IO (P = 0.00001). CONCLUSIONS: There is co-activation of the transversus abdominis/internal oblique and the pelvic floor muscles in young, asymptomatic nulliparous women. This pattern was modified in primigravid pregnant and primiparous postpartum women regardless of the delivery mode.

Pelvic floor muscle training program increases muscular contractility during first pregnancy and postpartum: electromyographic study.

AIMS: The aim of this study was to evaluate the effect of a training program over both pelvic floor muscles contractility and urinary symptoms in primigravid pregnant and postpartum primiparous women. PATIENTS AND METHODS: A clinical, prospective and blinded trial was conducted with 33 women divided into three groups: (G1) 13 primigravid pregnant women; (G2) 10 postpartum primiparous women (49.3 ± 5.84 days), after vaginal delivery with right mediolateral episiotomy; (G3) 10 postpartum primiparous women (46.3 ± 3.6 days), after cesarean section delivery. The evaluation was carried out using digital palpation (Modified Oxford Grading Scale), pelvic floor electromyography and, for the investigation of urinary symptoms, validated questionnaires (International Consultation on Incontinence Questionnaire-short form-ICIQ-UI SF and International Consultation on Incontinence Questionnaire Overactive Bladder-ICIQ-OAB). The protocol consisted of 10 individual sessions carried out by the physiotherapist through home visits, three times a week, with 60 min duration each. The statistical analysis was performed using ANOVA and Spearman's correlation coefficient. RESULTS: The pelvic floor muscle contractility increased after the training program (P = 0.0001) for all groups. Decreases in the scores of both ICIQ-UI SF (P = 0.009) and ICIQ-OAB (P = 0.0003) were also observed after training. CONCLUSION: Pelvic floor muscle training is an effective means for the increase in its own contractility in both primigravid pregnant and primiparous postpartum women, accompanied with a concomitant decrease in urinary symptoms.

[Validation of the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) for Portuguese]. / Validação do International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) para a língua portuguesa.

PURPOSE: To translate, culturally adapt and validate the questionnaire "International Consultation on Incontinence Questionnaire Overactive Bladder" (ICIQ-OAB) for the Portuguese Language. METHODS: Two Brazilian translators acquainted with the objectives of this research translated the ICIQ-OAB into Portuguese and both translations were back-translated by two other native English speaking translators. The differences between the versions were brought to agreement and pre-tested in a pilot study. The final version of the ICIQ-OAB was applied together with the previously translated and tested version of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) in 142 male and female patients with irritative urinary symptoms. For the validation of the ICIQ-OAB the following psychometric features were evaluated: reliability (internal consistency and test-retest) and validity of the survey. The retest was performed four weeks after the first interview. RESULTS: The reliability of the instrument was demonstrated through the Cronbach α Coefficient, with a general result of 0.7. The test-retest corroborated the stability of the instrument through the intraclass correlation coefficient and presented a result of 0.91 and 0.95 when compared to both the ICIQ-OAB and ICIQ-SF, respectively. When the instruments were compared by the Pearson correlation coefficient the result was 0.7 (p=0.0001), that confirms the validity of the study criterion. The concurrent validity was evaluated by the correlation between some clinical and sociodemographic variants and the ICIQ-OAB score. CONCLUSION: The culturally adapted version of the ICIQ-OAB translated into Brazilian Portuguese presented satisfactory reliability and survey validity and was considered valid for the evaluation of irritative urinary symptoms of Brazilian patients of both genders.

Impact of delivery mode on electromyographic activity of pelvic floor: comparative prospective study.

AIMS: Several studies evidenced the association between pregnancy, mode of delivery and genitourinary symptoms. However, there are still controversies about the role of mode of delivery in the prevention or aggravation of these symptoms. This study aimed to compare the impact of three distinct modes of delivery on pelvic floor muscle contractility. METHODS: Seventy-five primiparous women were divided into three groups: (1) vaginal delivery with mediolateral episiotomy (n = 28); (2) elective cesarean section (n = 26); (3) emergency cesarean section (n = 21). All patients underwent vaginal digital examination, grading the muscle contractility from 0 to 5 and surface electromyography (EMG) of the pelvic floor during the last trimester of pregnancy and 45 days after delivery. RESULTS: There was a significant increase in pelvic floor contractility in the elective cesarean section group, from 2.35 to 2.92 (P = 0.03), when compared to the vaginal delivery and emergency cesarean section groups. Analysis of electromyography data showed a significant reduction in maximum contraction of the pelvic floor after vaginal delivery, from 39.17 to 31.14 µV (P = 0.001), which was not observed in both cesarean section groups. CONCLUSION: Vaginal delivery was associated with a decrease in pelvic floor muscle strength and endurance 45 days after delivery when compared to elective cesarean section as well as emergency cesarean section.

Validação do International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) para a língua portuguesa / Validation of the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) for Portuguese

OBJETIVOS: traduzir, adaptar culturalmente e validar o questionário International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) para a língua portuguesa. MÉTODOS: dois tradutores brasileiros, cientes dos objetivos da pesquisa, traduziram o ICIQ-OAB para o português e as duas traduções geradas foram retrotraduzidas por outros dois tradutores ingleses. As diferenças entre as versões foram harmonizadas e pré-testadas em um estudo piloto. A versão final do ICIQ-OAB foi aplicada junto com a versão já traduzida e validada do questionário International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) em 142 pacientes, entre homens e mulheres, com sintomas miccionais irritativos. Para validação do ICIQ-OAB foram testadas propriedades psicométricas: confiabilidade (consistência interna e teste-reteste) e validade de construto. O reteste foi realizado quatro semanas após a primeira entrevista. RESULTADOS: a confiabilidade do instrumento foi avaliada por meio do Coeficiente α Cronbach, tendo como resultado geral 0,7. O teste-reteste avaliou a estabilidade do instrumento por meio do coeficiente de correlação intraclasse e apresentou resultado de 0,91 e 0,95, quando comparados aos questionários ICIQ-OAB e ICIQ-SF, respectivamente. Comparando os instrumentos por meio do coeficiente de correlação de Pearson foi encontrado 0,7 (p=0,0001), o que confirma a validade de critério do estudo. A validade concorrente foi avaliada pela correlação entre algumas variáveis sociodemográficas e clínicas e o escore final do ICIQ-OAB. CONCLUSÃO: a versão em português do ICIQ-OAB traduzida e adaptada culturalmente para o português do Brasil apresentou confiabilidade e validade de constructo satisfatórias e foi considerada válida para avaliação dos sintomas miccionais irritativos de pacientes brasileiros de ambos os sexos.

PURPOSE: to translate, culturally adapt and validate the questionnaire "International Consultation on Incontinence Questionnaire Overactive Bladder" (ICIQ-OAB) for the Portuguese Language. METHODS: two Brazilian translators acquainted with the objectives of this research translated the ICIQ-OAB into Portuguese and both translations were back-translated by two other native English speaking translators. The differences between the versions were brought to agreement and pre-tested in a pilot study. The final version of the ICIQ-OAB was applied together with the previously translated and tested version of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) in 142 male and female patients with irritative urinary symptoms. For the validation of the ICIQ-OAB the following psychometric features were evaluated: reliability (internal consistency and test-retest) and validity of the survey. The retest was performed four weeks after the first interview. RESULTS: the reliability of the instrument was demonstrated through the Cronbach α Coefficient, with a general result of 0.7. The test-retest corroborated the stability of the instrument through the intraclass correlation coefficient and presented a result of 0.91 and 0.95 when compared to both the ICIQ-OAB and ICIQ-SF, respectively. When the instruments were compared by the Pearson correlation coefficient the result was 0.7 (p=0.0001), that confirms the validity of the study criterion. The concurrent validity was evaluated by the correlation between some clinical and sociodemographic variants and the ICIQ-OAB score. CONCLUSION: the culturally adapted version of the ICIQ-OAB translated into Brazilian Portuguese presented satisfactory reliability and survey validity and was considered valid for the evaluation of irritative urinary symptoms of Brazilian patients of both genders.