(501) Past and Present Applications of Therapeutic Pelvic Massage

Abstract

Abstract Introduction Pelvic massage is remarkable for being one of the oldest and most durable therapeutic medical practices, used for the treatment of genital disease from the Ancient world until the present day. Although it is most commonly associated with diseases of women, especially the historical diagnosis of hysteria, in our modern era pelvic massage is used to treat disease in all human beings regardless of sex. Through the progress of medical specialization and technology, pelvic massage has evolved to become a specialist tool utilized by a subset of physical therapists, augmented by instruments such as wands and especially vibrators. Objective To describe how the justification for and application of therapeutic pelvic massage has evolved through the Western history of medicine, as a lens through which to appreciate the limitations of our contemporary understanding of this practice. Methods Review of primary and secondary sources pertaining to pelvic massage as a treatment for disease, in historical and contemporary medical professional and popular literature. Results Since the earliest documented use of therapeutic pelvic massage to treat female patients in Ancient Egyptian medical texts, doctors have recommended internal and external genital stimulation for various reasons. For most of Western medical history, this intervention was principally used to treat various symptoms that were diagnosed as hysteria in female patients, according to the logic that a wandering womb or collection of ill-humors could be stimulated to migrate into proper position through this means. During the past century, our medical scientific understanding of women’s bodies has expanded beyond hysteria ideology, to better appreciate the anatomic and physiologic similarities between male and female genital and pelvic structures and disease conditions. This evolution has been accompanied by an expansion of the patient populations perceived to benefit from pelvic massage, to include not only females of reproductive age, but older women, men, and transgender patients. Ironically, at the same time that therapeutic pelvic massage has come to rest on a more scientifically sound foundation, its use by urologic and gynecologic surgeons decreased, and it is now practiced primarily by pelvic physical therapists and self-administered by patients utilizing pelvic wand and vibratory technologies. Conclusions Pelvic massage has stood the test of time as an empiric treatment for various diseases, but its etiologic justification has changed significantly over millennia. Whereas previously it was believed to treat specifically uterine disorders in hysterical women, it is now understood to affect the muscle and connective tissues of the pelvic floor, as well as secretory genital structures such as the vagina and prostate. Whether because of its previous attachment to now-defunct hysteria ideology or its current administration by non-physicians, the scientific study of pelvic massage continues to lag behind its application. As referrals to pelvic physical therapy and pelvic wand and vibrator sales increase, further study of the indications for and effects of these interventions is warranted to ensure the ethical and effective application of these resources. Disclosure No