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Interventional treatment for myofascial pelvic floor pain in women: systematic review with meta-analysis

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Abstract

Introduction and hypothesis

Female myofascial pain (MFP) of the pelvic floor muscles (PFM) is a subtype of chronic pelvic pain associated with urinary, anorectal, and sexual symptoms, such as dyspareunia. Treatment remains poorly discussed, and we hypothesized that different treatments could improve outcomes versus placebo or no treatment.

Methods

A systematic review (CRD 42020201419) was performed in June 2020 using the following databases: PubMed, Cochrane Library, Web of Science, Embase, Scopus, BVSalud, Clinicaltrials.gov, and PEDro, including randomized clinical trials related to MPF of PFM. Primary outcome was pain after treatment, and secondary outcomes were quality of life and sexual function. Risk of bias and quality of evidence (GRADE criteria) were evaluated. Meta-analysis for continuous variables was performed (mean difference between baseline and treatment and post-treatment mean between groups).

Results

Five studies were included (n = 218). Final mean VAS score (GRADE: very low) after 4 weeks of treatment (p = 0.14) and the mean difference from baseline and 4 weeks (p = 0.66) between groups were not different between the intervention and control groups. Quality of life according to the SF-12 questionnaire (GRADE: very low) followed the same pattern. However, sexual function (GRADE: low) according to the total FSFI score (MD = -5.07 [−8.31, -1.84], p < 0.01, i2 = 0%) and the arousal, orgasm, and pain domains improved in the intervention groups when the mean difference from baseline and 4 weeks was compared with controls.

Conclusion

Pain and quality of life after 4 weeks of heterogeneous intervention differed between the intervention and control groups in sexual function: FSFI in studies improved in almost all domains. VAS (in three studies) and SF-12 (in two studies) failed to demonstrate differences.

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Funding

Sao Paulo Research Agency (FAPESP) grant 2019/26723–5 and Coordenação de Aperfeicoamento de Ensino Superior code 001 scholarships for, respectively, GMV Pereira and ALB Lunardi.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101, Cidade Universitária, Campinas, SP, Brazil

    Claudia Pignatti Frederice, Luiz Gustavo Oliveira Brito, Glaucia Miranda Varella Pereira & Cássia Raquel Teatin Juliato

  2. Department of Physiotherapy, Unimetrocamp University Center, Campinas, Brazil

    Claudia Pignatti Frederice

  3. Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil

    Anna Lygia Barbosa Lunardi

Authors
  1. Claudia Pignatti Frederice
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  2. Luiz Gustavo Oliveira Brito
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  3. Glaucia Miranda Varella Pereira
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  4. Anna Lygia Barbosa Lunardi
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  5. Cássia Raquel Teatin Juliato
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Contributions

CP Frederice: Project development, recruitment, data management, data analysis, manuscript writing, and approval of the final manuscript.

GMV Pereira, ALB Lunardi: Data management, data analysis, manuscript writing, and approval of the final manuscript.

LGO Brito: Data management/analysis, manuscript editing, and approval of the final manuscript.

CRT Juliato: Project development, data analysis, manuscript editing, and approval of the final manuscript.

Corresponding author

Correspondence to Cássia Raquel Teatin Juliato.

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Frederice, C.P., Brito, L.G.O., Pereira, G.M.V. et al. Interventional treatment for myofascial pelvic floor pain in women: systematic review with meta-analysis. Int Urogynecol J 32, 1087–1096 (2021). https://doi.org/10.1007/s00192-021-04725-x

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  • DOI: https://doi.org/10.1007/s00192-021-04725-x

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