The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction (CME).

INTRODUCTION: Chronic pelvic pain (CPP) in women and men is associated with significant sexual dysfunction. Recently, musculoskeletal factors have been recognized as significant contributors to the mechanism of pelvic pain and associated sexual dysfunction, and in particular, pelvic floor muscle hypertonus has been implicated. AIM: The purpose of this Continuing Medical Education article is to describe the musculoskeletal components involved in pelvic and genital pain syndromes and associated sexual dysfunction, introduce specific physical therapy assessment and intervention techniques, and provide suggestions for facilitating an effective working relationship among practitioners involved in treating these conditions. METHODS: A review of the relevant literature was performed, clarifying current definitions of pelvic pain, elucidating the role of musculoskeletal factors, and determining the efficacy of physical therapy interventions. RESULTS: A review of the role of physical therapy for the treatment of pelvic pain and related sexual dysfunction. CONCLUSIONS: Physical therapy treatment of pelvic pain is an integral component of the multidisciplinary approach to CPP and associated sexual dysfunction.

Postpartum sexuality concerns among first-time parents from one U.S. academic hospital.

INTRODUCTION: Sexual perceptions and activities are influenced by pregnancy and childbirth due to both physical and emotional changes. AIM: Our goal was to illuminate the sexuality issues of concern to first-time parents (mothers and fathers) of healthy, singleton newborns in one U.S. academic hospital. MAIN OUTCOME MEASURES: Number of sexuality concerns and self-reported degree of resolution by months postpartum and gender of parent. METHODS: Anonymous, cross-sectional postal survey of two first-time parent cohorts: 4 months postpartum (113 responses/404 mailed = 28.0%) and 12 months postpartum (99 responses/394 mailed = 25.1%). RESULTS: Approximately half of the parents reported questions or concerns on between two and eight of 19 sexuality topics. Only 11% of participating mothers and 17% of participating fathers had one or no concerns (P = 0.27 by gender), and 17% of mothers and 9% of fathers had >13 concerns (P = 0.12 by gender). There were fewer maternal concerns if they did not live with the father (P = 0.01), slightly fewer if the delivery was vaginal vs. cesarean (P = 0.07), and no differences by forceps/vacuum use or episiotomy/vaginal tear. The top concerns at 4 months postpartum were quite similar by gender and included when to resume intercourse, birth control, and the sexual impact of physical recovery from delivery. At 12 months, mothers and fathers both frequently reported a sexuality impact from the mother's body image concerns and desire discrepancy. One year postpartum, there were three sexuality topics with fairly high prevalence (more than one-third parents had this concern) that persisted (no self-reported resolution among at least one-third of parents): child-rearing differences with spouse, greater desire by the man than the woman, and the mother's body image. CONCLUSIONS: New mothers and fathers both have postpartum sexuality concerns/questions, many of which can be addressed by healthcare providers.