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Background and Purpose
Musculoskeletal dysfunction is a known cause of dyspareunia and a reason for referral for physical therapist management. The purpose of this case report is to describe the physical therapist management of a patient with dyspareunia and overactivity of the pelvic-floor muscles with a limited number of visits and a focus on self-management strategies.
Case Description
This case involved a 30-year-old married woman with levator ani muscle overactivity and dyspareunia that was 1 year in duration.
Intervention
The therapist explained the anatomy and function of the pelvic-floor muscles during intercourse, instructed the patient on how to control the levator ani muscles, and instructed her on vaginal self-dilation techniques.
Outcomes
The patient attended 3 physical therapy sessions over a period of 9 weeks. She performed vaginal self-dilation at home. She rated pain during intercourse as 0/10 on a verbal rating scale and had no remaining tenderness in the levator ani muscles at discharge.
Discussion
Some women with dyspareunia may improve with an intervention that emphasizes education and vaginal self-dilation techniques. Future research should compare home-based and clinic-based treatments.
Dyspareunia is pain before, during, or after intercourse.1 Dyspareunia in women can have a significant negative effect on quality of life and may affect between 20% and 50% of all women.2 Mathias et al3 reported that 88% of women surveyed who had pelvic pain and were sexually active stated that they had pain during intercourse in the previous month. These reports likely underestimate the true prevalence of dyspareunia, because many women with dyspareunia do not seek medical treatment.4
Possible causes of dyspareunia include injury to the pelvic area during childbirth, vulvar atrophy, endometriosis, pelvic inflammatory disease, infection, adhesions, and interstitial cystitis.4 Psychosocial factors such as depression, physical or sexual abuse, and anxiety also are possible causes of dyspareunia.5 Women with dyspareunia, however, are less likely to report a history of physical or sexual abuse compared with women diagnosed with pelvic pain.4 Musculoskeletal dysfunction, specifically muscle pain and overactivity of the levator ani muscles, is another cause of dyspareunia documented in the literature.1,2,6-9 Overactivity of the levator ani muscles is a condition in which these muscles do not relax completely, or contract when they should relax.1 Overactive, nonrelaxing muscles are painful to touch, and pain itself...