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Management of Dyspareunia and Associated Levator Ani Muscle Overactivity

KA Fisher, PT, MPT, is Director, Pelvic Floor Rehabilitation Unit, OU Pelvic and Bladder Health Clinic, 825 NE 10th, Ste 3400, Oklahoma City, OK 73104 (USA); Clinical Instructor, Section of Female Pelvic Medicine and Reconstructive Surgery/Urogynecology, Department of Obstetrics and Gynecology; and Clinical Instructor, Department of Rehabilitation Sciences, University of Oklahoma Health Science Center, Oklahoma City, Okla.

Kimberly-A-Fisher{at}ouhsc.edu

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.

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