Overview and Introduction to Women's Pelvic Health: Difference between revisions

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* Diminished or painful orgasm
* Diminished or painful orgasm
* Sexual trauma<ref>DiMauro J, Renshaw KD, Blais RK. Sexual vs. non-sexual trauma, sexual satisfaction and function, and mental health in female veterans. J Trauma Dissociation. 2018;19(4):403-16.</ref><ref>Sobel L, O'Rourke-Suchoff D, Holland E, Remis K, Resnick K, Perkins R et al. Pregnancy and childbirth after sexual trauma: patient perspectives and care preferences. Obstet Gynecol. 2018;132(6):1461-8.</ref>
* Sexual trauma<ref>DiMauro J, Renshaw KD, Blais RK. Sexual vs. non-sexual trauma, sexual satisfaction and function, and mental health in female veterans. J Trauma Dissociation. 2018;19(4):403-16.</ref><ref>Sobel L, O'Rourke-Suchoff D, Holland E, Remis K, Resnick K, Perkins R et al. Pregnancy and childbirth after sexual trauma: patient perspectives and care preferences. Obstet Gynecol. 2018;132(6):1461-8.</ref>
'''Women in the childbearing years may present with:'''<ref name=":0" />
* Prenatal or pregnancy concerns such as:
** Low back pain
** [[Recognising Pelvic Girdle Pain|Pubic symphysis or pelvic girdle pain (PGP)]]
** Vulvar varicosities
*** Varicose veins of the vulva are dilated veins in the labia majora and labia minora. They occur in between 22 and 34 percent of women who have varicose veins of the pelvis and in 18 to 22 percent of women who are pregnant<ref name=":3">Gavrilov SG. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500487/ Vulvar varicosities: diagnosis, treatment, and prevention]. ''Int J Womens Health''. 2017;9:463-75.</ref>
*** They are linked to venous thromboembolic events, superficial dyspareunia, and vulvodynia, as well as psycho-emotional and social issues<ref name=":3" />
* Sciatic pain
* Postural concerns
* Other orthopaedic conditions
* Intrapartum care - during actual labour and delivery
* Postnatal care including breastfeeding-related assistance
* Abdominal rehabilitation
* [[Cesarean Section|Cesarean rehabilitation]]
* Fertility challenges
* Return to sports, athletics and exercise


== References ==
== References ==

Revision as of 00:21, 25 November 2021

Original Editor - Jess Bell based on the course by Ibukun Afolabi
Top Contributors - Jess Bell, Kim Jackson, Wanda van Niekerk and Lucinda hampton
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Introduction[edit | edit source]

When introducing women's pelvic health physiotherapy, it is important  to understand the distinction between a “women’s health physiotherapist” and a “pelvic health physiotherapist”.[1]

Women’s health physiotherapists typically treat female issues such as:[1]

They may or may not treat pelvic health conditions.

Pelvic health physiotherapists may also take a whole-body approach, but they also work directly over the pelvic floor structures.  They may treat men, women, children, and diverse genders.[1]

This page focuses on introducing women’s pelvic health physiotherapy. In particular, it explores:

  • The Who:
    • Who do women’s pelvic health physiotherapists work with?
  • The Why:
    • Why do they do what they do?
  • The How:
    • How do they best serve women who present with pelvic health concerns and conditions?

1. The Who[edit | edit source]

Women’s pelvic health physiotherapists treat a range of clinical conditions, that are classically categorised as:[1]

  • Urological
  • Gynaecological
  • Gastroenterological
  • Oncological
  • Geriatric
  • Surgical
  • Orthopaedic
  • Obstetric
  • Chronic (i.e. persistent pain conditions)

However, these categories are somewhat arbitrary as women might present with conditions that fall into a number of different areas. For instance, a woman who has vaginismus and pelvic girdle pain would fall into the orthopaedic, obstetric, chronic pain, and gynecological categories. Pelvic health physiotherapists must, therefore, consider the woman as a whole.[1]

Specific conditions that might be encountered in women’s pelvic health physiotherapy include the following:[1]

Women across the lifespan living with:

  • Urinary incontinence
    • An involuntary loss of urine, which affects millions of people around the world[2]
    • Specific prevalence rates vary from 5 to 70 percent, but prevalence increases with age - more than 40 percent of women aged over 70 years are affected[3]
  • Faecal incontinence
    • An involuntary loss of stool (either liquid or solid), which affects up to 20 percent of women[4]
  • Constipation https://www.physio-pedia.com/Constipation
  • Bladder urgency and frequency
    • Urgency is defined as "An abrupt, strong, often overwhelming, need to urinate”[5]
    • Frequency is defined as “Abnormally frequent urination”[5]
  • Bladder  hesitancy / underactive bladder
    • Patients with bladder hesitancy experience “a slow urinary stream, hesitancy and straining to void, with or without a feeling of incomplete bladder emptying and dribbling, often with storage symptoms”[6]
  • Bladder pain
  • Pelvic organ prolapse (POP)
    • Occurs when there is descent of one or more parts of the vagina and uterus, which enables other organs to herniate into the vaginal space (cystocele, rectocele, or enterocele)[7]
    • POP can cause pressure (with or without a bulge), sexual dysfunction and it can disrupt lower urinary tract or bowel function[7]

Women across the lifespan living with chronic pelvic, vulvar or vaginal conditions such as:[1]

  • Polycystic ovarian syndrome (PCOS)
    • PCOS is considered the  most common hormonal disorder in women who are of reproductive age
    • Individuals experience at least two of the following signs: irregular periods, hyperandrogenism (i.e. high levels of androgens), and polycystic ovaries[8]
  • Dysmenorrhea / period pain
    • Affects around 75 percent of women during their reproductive life. It is particularly common in during teenage years and early adult life[9]
  • Interstitial cystitis or painful bladder syndrome
    • A chronic condition that causes pelvic pain, pressure or discomfort that the patient perceives is associated with the bladder. Other urinary symptoms associated with Interstitial cystitis include a persistent urge to void / urinary frequency without any other cause / condition being present[10]
  • Endometriosis
    • Most common cause of chronic pelvic pain in women. It is a complex condition associated with an "estrogen-dependent chronic inflammatory process", which largely affects pelvic structures, including the ovaries. It is associated with infertility[11]
  • Coccydynia / coccyx pain
    • Has many traumatic and non-traumatic causes. Middle-aged women are most often affected, but it can occur in anyone at any age[12]
  • Vulvodynia
    • Vulva pain that occurs during sexual and non-sexual situations.  It occurs in 8 to 10 percent of all women[13]
  • Provoked vestibulodynia
    • Vulva pain, localised to the vestibule, which has been present for 3 months or more. Pain is provoked by touch and sexual activity and there is no clear identifiable cause[14]

Women across the lifespan with female sexual health concerns such as:[1]

  • Dyspareunia or primary or secondary vaginismus
    • Dyspareunia is recurrent / persistent genital pain, which is associated with sexual intercourse. Both men and women can have dyspareunia, but it is more common in women[15]
    • In vaginismus, vaginal spasms prevent penetration during sexual intercourse[16]
  • Anorgasmia
  • Diminished or painful orgasm
  • Sexual trauma[17][18]

Women in the childbearing years may present with:[1]

  • Prenatal or pregnancy concerns such as:
    • Low back pain
    • Pubic symphysis or pelvic girdle pain (PGP)
    • Vulvar varicosities
      • Varicose veins of the vulva are dilated veins in the labia majora and labia minora. They occur in between 22 and 34 percent of women who have varicose veins of the pelvis and in 18 to 22 percent of women who are pregnant[19]
      • They are linked to venous thromboembolic events, superficial dyspareunia, and vulvodynia, as well as psycho-emotional and social issues[19]
  • Sciatic pain
  • Postural concerns
  • Other orthopaedic conditions
  • Intrapartum care - during actual labour and delivery
  • Postnatal care including breastfeeding-related assistance
  • Abdominal rehabilitation
  • Cesarean rehabilitation
  • Fertility challenges
  • Return to sports, athletics and exercise

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Afolabi I. Overview and Introduction to Women's Pelvic Health Course. Physioplus, 2021.
  2. ↑ Pizzol D, Demurtas J, Celotto S, Maggi S, Smith L, Angiolelli G et al. Urinary incontinence and quality of life: a systematic review and meta-analysis. Aging Clin Exp Res. 2021;33(1):25-35.
  3. ↑ Milsom I, Gyhagen M. The prevalence of urinary incontinence. Climacteric. 2019;22(3):217-22.
  4. ↑ D'Amico F, Wexner SD, Vaizey CJ, Gouynou C, Danese S, Peyrin-Biroulet L. Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review. United European Gastroenterol J. 2020;8(8):886-922.
  5. ↑ 5.0 5.1 Wrenn K. Dysuria, Frequency, and Urgency. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 181. Available from: https://www.ncbi.nlm.nih.gov/books/NBK291/
  6. ↑ Uren AD, Drake MJ. Definition and symptoms of underactive bladder. Investig Clin Urol. 2017;58(Suppl 2):S61-S67.
  7. ↑ 7.0 7.1 The American College of Obstetricians and Gynecologists and the American Urogynecologic Society INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect the US Food and Drug Administration order to stop the sale of transvaginal synthetic mesh products for the repair of pelvic organ prolapse. Pelvic Organ Prolapse. Female Pelvic Medicine & Reconstructive Surgery. 2019;25(6):397-408.
  8. ↑ Rasquin Leon LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2021 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/
  9. ↑ Armour M, Parry K, Manohar N, Holmes K, Ferfolja T, Curry C et al. The prevalence and academic impact of dysmenorrhea in 21,573 young women: a systematic review and meta-analysis. J Womens Health (Larchmt). 2019;28(8):1161-71.
  10. ↑ Homma Y, Akiyama Y, Tomoe H, Furuta A, Ueda T, Maeda D et al. Clinical guidelines for interstitial cystitis/bladder pain syndrome. Int J Urol. 2020;27(7):578-89.
  11. ↑ Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, Kohlmeier A et al. Endometriosis. Endocr Rev. 2019;40(4):1048-1079.
  12. ↑ White WD, Avery M, Jonely H, Mansfield JT, Sayal PK, Desai MJ. The interdisciplinary management of coccydynia: A narrative review. PM&R: The Journal of Injury, Function and Rehabilitation. 2021; 1- 12.
  13. ↑ Bergeron S, Reed BD, Wesselmann U, Bohm-Starke N. Vulvodynia. Nat Rev Dis Primers. 2020;6(1):36.
  14. ↑ Henzell H, Berzins K, Langford JP. Provoked vestibulodynia: current perspectives. Int J Womens Health. 2017;9:631-42.
  15. ↑ Arora V, Mukhopadhyay S, Morris E. Painful sex (dyspareunia): a difficult symptom in gynecological practice. Obstetrics, Gynaecology & Reproductive Medicine. 2020;30(9):269-75.
  16. ↑ Achour R, Koch M, Zgueb Y, Ouali U, Ben Hmid R. Vaginismus and pregnancy: epidemiological profile and management difficulties. Psychol Res Behav Manag. 2019;12:137-43.
  17. ↑ DiMauro J, Renshaw KD, Blais RK. Sexual vs. non-sexual trauma, sexual satisfaction and function, and mental health in female veterans. J Trauma Dissociation. 2018;19(4):403-16.
  18. ↑ Sobel L, O'Rourke-Suchoff D, Holland E, Remis K, Resnick K, Perkins R et al. Pregnancy and childbirth after sexual trauma: patient perspectives and care preferences. Obstet Gynecol. 2018;132(6):1461-8.
  19. ↑ 19.0 19.1 Gavrilov SG. Vulvar varicosities: diagnosis, treatment, and prevention. Int J Womens Health. 2017;9:463-75.
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