Changes in pelvic floor morphometry and muscle function after multimodal physiotherapy for gynaecological cancer survivors suffering from dyspareunia: a prospective interventional study

Abstract

ObjectiveTo investigate the changes in pelvic floor morphometry and muscle function after multimodal pelvic floor physiotherapy treatment in gynaecological cancer survivors suffering from painful intercourse (dyspareunia). DesignProspective interventional study. SettingThree university hospitals. ParticipantsThirty-one gynaecological cancer survivors with dyspareunia. InterventionThe treatment consisted of 12 weekly sessions of physiotherapy combining education, pelvic floor muscle exercises with biofeedback, manual therapy and home exercises. Main outcome measuresWomen were assessed at baseline and post-treatment. Pelvic floor morphometry was evaluated at rest and on maximal contraction by measuring bladder neck position, anorectal and levator plate angles as well as levator hiatal dimensions with three-dimensional/four-dimensional transperineal ultrasound imaging. Pelvic floor muscle function was evaluated by measuring passive forces (muscle tone measure), flexibility, stiffness, strength, coordination and endurance with an intra-vaginal dynamometric speculum. ResultsSignificant changes in pelvic floor morphometry and muscle function were found post-treatment. The parameters assessing the changes from rest to maximal contraction significantly improved (e.g., mean change of levator hiatal area narrowing 14%, 95% CI 11–18, Cohen’s d effect size 1.48)), supporting the hypothesis of decreased muscle tone and improved muscle contractility following treatment. Women also presented with a significant decrease in tone (mean change -0.4N, 95% CI −0.7 to −0.1, Cohen’s d effect size 0.57) and stiffness (mean change −0.1N/mm, 95% CI −0.2 to −0.1, Cohen’s d effect size 0.59), as well as significant improvements in flexibility (mean change 9.0mm, 95% CI 5.8–12.2, Cohen’s d effect size 1.08), coordination (mean change 3 rapid contractions, 95% CI 2–4, Cohen’s d effect size 0.85) and endurance (mean change 683%*s, 95% CI 388–978, Cohen’s d effect size 0.90). ConclusionOur findings suggest significant improvements in pelvic floor morphometry and muscle function after a multimodal physiotherapy treatment in gynaecological cancer survivors with dyspareunia. These effects may represent key treatment mechanisms to reduce dyspareunia, supporting the rationale for multimodal physiotherapy in this population. Clinical trial registration number (ClinicalTrials.gov)NCT03935698.