The Puzzle of Pelvic Pain: A Rehabilitation Framework for Balancing Tissue Dysfunction and Central Sensitization II A Review of Treatment Considerations

Nonsurgical neovagina creation in congenital vaginal agenesis: a case report of movement-based dilator therapy

Objective

To report the use of progressive, high-frequency movement-based dilator therapy (MBDT) to create a neovagina in a patient with congenital vaginal agenesis.

Design

Case report.

Setting

Tertiary care military hospital.

Patients

A 22-year-old woman with congenital vaginal agenesis.

Interventions

Self-directed MBDT.

Main Outcome Measures

Vaginal elongation by self-directed MBDT.

Results

The patient achieved a 6.5-cm vaginal length after 6 pelvic health physical therapy sessions over a span of 4 months of progressive, high-frequency MBDT.

Conclusions

Progressive, high-frequency MBDT should be considered as part of a first-line dilator therapy regimen for patients with congenital vaginal agenesis interested in creating a neovagina.

The Role of Physical Therapy in Sexual Health in Men and Women: Evaluation and Treatment

INTRODUCTION

Many conditions of pelvic and sexual dysfunction can be addressed successfully through pelvic floor physical therapy (PFPT) through various manual therapy techniques, neuromuscular reeducation, and behavioral modifications. The field of pelvic rehabilitation, including sexual health, continues to advance to modify these techniques according to a biopsychosocial model.

AIM

To provide an update on peer-reviewed literature on the role of PFPT in the evaluation and treatment of pelvic and sexual dysfunctions in men and women owing to the overactive and the underactive pelvic floor.

METHODS

A literature review to provide an update on the advances of a neuromusculoskeletal approach to PFPT evaluation and treatment.

MAIN OUTCOME MEASURE

The use and advancement of PFPT methods can help in successfully treating pelvic and sexual disorders.

RESULTS

PFPT for pelvic muscle overactivity and underactivity has been proven to be a successful option for pelvic and sexual dysfunction. Understanding the role of the organs, nerves, fascia, and musculoskeletal system in the abdomino-pelvic and lumbo-sacro-hip region and how pelvic floor physical therapists can effectively evaluate and treat pelvic and sexual health. It is important for the treating practitioner to know when to refer to PFPT.

CONCLUSION

Neuromusculoskeletal causes of pelvic floor disorders affect a substantial proportion of men, women, and children and PFPT is a successful and non-invasive option. Pelvic floor examination by healthcare practitioners is essential in identifying when to refer to PFPT. Use of a biopsychosocial model is important for the overall well-being of each patient. Further research is needed. Stein A, Sauder SK, Reale J. The role of physical therapy in sexual health in men and women: Evaluation and treatment. Sex Med Rev 2019;7:46-56.