The ultra-Orthodox Jewish couple in Israel: an interdisciplinary sex therapy case study.

Treatment for couples presenting with sexual difficulties should consider the context of the couple's lives and their cultural milieu. Practitioners treating couples from traditional and faith-based societies should acknowledge, respect, and be willing to modify treatment to conform to the clients' beliefs. The purpose of this article is to describe the case of a young ultra-Orthodox couple presenting with unconsummated marriage and to illustrate and elucidate the multidisciplinary and culturally sensitive treatment provided.

Physical therapy treatment of persistent genital arousal disorder during pregnancy: a case report.

INTRODUCTION: Persistent genital arousal disorder (PGAD) is described as the spontaneous, intrusive, and unwanted genital arousal in the absence of sexual interest and desire. Whether the etiology of this disorder is essentially central or peripheral is unclear; however, a presenting symptom may be persistent engorgement of genital erectile and vascular tissue. AIM: To describe a case of a distressed 27 year old pregnant woman with symptoms consistent with PGAD, and the intervention leading to the resolution of symptoms. METHODS: A patient with symptoms of PGAD was assessed. Information regarding this condition was offered. A manual therapy treatment was provided to decrease muscle hypertonus near the pudendal nerve, and a home intervention was suggested. RESULTS: Complete resolution of symptoms per patient's report 1 week later. CONCLUSION: Treatment with pelvic floor manual therapy directed at the pudendal nerve may provide safe and significant relief from PGAD symptoms in a pregnant woman patient.

Musculoskeletal pain and sexual function in women.

INTRODUCTION: Sexual pain disorders refer to conditions of genital pain that interfere with intercourse. They often have a musculoskeletal component related to the pelvic floor and are included in the DSM-IV as sexual dysfunctions. Musculoskeletal pain (MP) that is not essentially genitally based often interferes with sex as well yet is not considered a distinct sexual dysfunction. MP is generally addressed by physiatrists, orthopedists, and rheumatologists who are not traditionally trained in sexual medicine, and therefore, the sexual concerns of women with MP often go unaddressed. AIM: The purposes of this review article were to describe how MP is perceived in the literature as affecting sexual function, illustrate how specific MP conditions prevalent in women may affect sexual function, and offer recommendations for clinical practice. METHODS: PubMed and Medline searches were performed using the keywords "musculoskeletal pain and sex,""lower back pain and sex,""arthritis and sex," and "fibromyalgia and sex". Main Outcome Measure. Review of the peer-reviewed literature. RESULTS: Most studies cite fatigue, medication, and relationship adjustment as affecting sexuality much as chronic illness does. While musculoskeletal contributors to genital sexual response and pain are considered relevant to sexual function, little is understood about how MP syndromes specifically affect sexual activity. CONCLUSION: Lack of mobility and MP can restrict intercourse and limit sexual activity, and gender differences are noted in response to pain. Sexual and relationship counseling should be offered as a component of rehabilitative treatment. Physical therapists are uniquely qualified to provide treatment to address functional activities of daily living, including sexual intercourse, and offer advice for modifications in positioning.

Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review.

INTRODUCTION: The sphincteric and supportive functions of the pelvic floor are fairly well understood, and pelvic floor rehabilitation, a specialized field within the scope and practice of physical therapy, has demonstrated effectiveness in the treatment of urinary and fecal incontinence. The role of the pelvic floor in the promotion of optimal sexual function has not been clearly elucidated. AIM: To review the role of the pelvic floor in the promotion of optimal sexual function and examine the role of pelvic floor rehabilitation in treating sexual dysfunction. MAIN OUTCOME MEASURE: Review of peer-reviewed literature. RESULTS: It has been proposed that the pelvic floor muscles are active in both male and female genital arousal and orgasm, and that pelvic floor muscle hypotonus may impact negatively on these phases of function. Hypertonus of the pelvic floor is a significant component of sexual pain disorders in women and men. Furthermore, conditions related to pelvic floor dysfunction, such as pelvic pain, pelvic organ prolapse, and lower urinary tract symptoms, are correlated with sexual dysfunction. CONCLUSIONS: The involvement of the pelvic floor in sexual function and dysfunction is examined, as well as the potential role of pelvic floor rehabilitation in treatment. Further research validating physical therapy intervention is necessary.

Physiotherapy treatment of sexual pain disorders.

Physiotherapists provide treatment to restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease. Women with vulvar pain, dyspareunia, or vaginismus have limited ability to function sexually and often present with musculoskeletal and neurological findings appropriately addressed by a trained physiotherapist. Although pelvic floor surface electromyography (sEMG) biofeedback has been studied, the inclusion of physiotherapy in the team approach to treating women with sexual pain disorders is a relatively recent advancement, and its exact role is not widely understood by doctors, mental health professionals, or laypersons. This article will examine the supportive and often primary role of the physiotherapist in the overlapping conditions of vaginismus and dyspareunia.