Skip to main content

Assessment of pelvic floor muscles in women with deep endometriosis



To assess function and prevalence of spasms and trigger points of the pelvic floor muscles in women with deep endometriosis.


One hundred and four (104) patients were assessed. Group 1 (G1) was composed of 52 subjects diagnosed with deep endometriosis proven by magnetic resonance imaging (MRI); Group 2 (G2) was composed of 52 women with no signs of endometriosis. Subjects from both G1 and G2 were seen at the Division of Pelvic Pain and Endometriosis and at Center for Prevention of Sexually Transmitted Diseases, both at Federal University of São Paulo (UNIFESP), respectively. A full physical therapy evaluation was carried out, including medical history, presence of dyspareunia and physical examination, which included detailed evaluation of pelvic floor muscles and occurrence of muscle spasm, trigger point and muscle function.


The average age of the subjects in the study group was 36.4 and 30.9 years in the control group (p = 0.002). A greater prevalence of deep dyspareunia was found in the subjects in the endometriosis group when compared to the control group (p = 0.010). Women in G1 had higher prevalence of muscle spasms. In this group, 53.9 % had spasms—compared to only 17.3 % of women in G2 (p < 0.001). On the other hand, no significant difference between the groups (p = 0.153) was found while searching for the presence of trigger points.


Women with deep endometriosis have increased prevalence of pelvic floor muscle spasms when compared to the control group.

This is a preview of subscription content, access via your institution.


  1. Haas D, Chvatal R, Reichert B, Renner S, Shebl O, Binder H, Wurm P, Oppelt P (2012) Endometriosis: a premenopausal disease? Age pattern in 42,079 patients with endometriosis. Arch Gynecol Obstet 286(3):667–670. doi:10.1007/s00404-012-2361-z

    Article  PubMed  Google Scholar 

  2. Del Frate C, Girometti R, Pittino M, Del Frate G, Bazzocchi M, Zuiani C (2006) Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. RadioGraphics 26:1705–1718

    Article  PubMed  Google Scholar 

  3. Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL (2003) Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod 18(4):756–759

    CAS  Article  PubMed  Google Scholar 

  4. Matsuzaki S, Canis M, Poully JL, Rabischong B, Botchorishvili R, Mage G (2006) Relationship between delay of surgical diagnosis and severity of disease in patients with symptomatic deep infiltrating endometriosis. Fertil Steril 86(5):1314–1316

    Article  PubMed  Google Scholar 

  5. Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, Tammaa A, Salzer H (2012) Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 27(12):3412–3416

    CAS  Article  PubMed  Google Scholar 

  6. Marques A, Bahamondes L, Aldrighi JM, Petta CA (2004) Quality of life in Brazilian women with endometriosis assessed through a medical outcome questionnaire. J Reprod Med 49(2):115–120

    PubMed  Google Scholar 

  7. Baker PK (1993) Musculoskeletal origins of chronic pelvic pain—diagnosis e treatment. Obstet Ginecol Clin N Am 20(4):719–743

    CAS  Google Scholar 

  8. FitzGerald MP, Kotarinos R (2003) Rehabilitation of the short pelvic floor. I: background and patient evaluation. Int Urogynecol J 14:261–268

    CAS  Article  Google Scholar 

  9. Lukic A, Di Properzio M, De Carlo S, Nobili F, Schimberni M, Bianchi P, Prestigiacomo C, Moscarini M, Caserta D (2015) Quality of sex life in endometriosis patients with deep dyspareunia before and after laparoscopic treatment. Arch Gynecol Obstet. doi:10.1007/s00404-015-3832-9

    PubMed  Google Scholar 

  10. Rolf IP (1999) A articulação que determina a assimetria. In: Rolfing: a Integração das Estruturas Humanas. Martina Fontes, São Paulo, p 127–136

    Google Scholar 

  11. Doggweiler-Wiygul R, Wiygul JP (2002) Interstitial cystitis, pelvic pain, and the relationship to myofascial pain and dysfunction: a report on four patients. J Urol 20:310–314

    Google Scholar 

  12. Lavelle ED, Lavelle W, Smith HS (2007) Myofascial trigger points. Med Clin N Am 91:229–239

    Article  PubMed  Google Scholar 

  13. Yap EC (2007) Myofascial pain—an overview. Ann Acad Med Singap 36(1):43–48

    PubMed  Google Scholar 

  14. Guerineau M, Labat JJ, Sibert L, Delavierre D, Rigard J (2010) Traitement de la composante musculosquelettiqeu des douleurs pelvipérinéales chroniques. Progrès en urologie 20:1013–1110

    Article  Google Scholar 

  15. Weiss JM (2001) Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 166:2226–2231

    CAS  Article  PubMed  Google Scholar 

  16. Bo K, Finckenhagen HB (2001) Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and squeeze pressure. J Urol 169(6):2428–2429

    Google Scholar 

  17. Talasz H, Himmer-Perschak G, Marth E, Fischer-Colbrie J, Hoefner E, Lechleitner M (2008) Evaluation of pelvic floor muscle function in a randon group of adult women in Austria. Int Urogynecol J 19:131–135

    CAS  Article  Google Scholar 

  18. Deguara CS, Pepas L, Davis C (2012) Does minimally invasive surgery for endometriosis improve pelvic symptoms and quality of life? Curr Opin Obstet Gynecol 24(4):241–244

    Article  PubMed  Google Scholar 

  19. Roman H, Vassilieff M, Gourcerol G, Savoye G, Leroi AM, Marpeau L, Michot F, Tuech JJ (2011) Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptomguided approach. Hum Reprod 26(2):274–281

    Article  PubMed  Google Scholar 

  20. Neville CE, Fitzgerald CM, Mallinson T, Badillo S, Hynes C, Tu F (2012) A preliminary report of musculoskeletal dysfunction in female chronic pelvic pain: a blinded study of examination findings. J Bodyw Mov Ther 16:50–56

    Article  PubMed  Google Scholar 

  21. Tu FF, Holt J, Gonzáles J, Fitzgerald CM (2008) Physical therapy evaluation of patients with chronic pelvic pain: a controlled study. Am J Obstet Gynecol 272(e1-272):e7

    Google Scholar 

  22. Montenegro MLLS, Lemes EC, Vasconcelos M, Silva JCRE, Nogueira AA, Reis FJC, Poli Neto OB (2010) Importance of pelvic floor muscle tenderness evaluation in women with chronic pelvic pain. Pain Med 11:224–228

    Article  PubMed  Google Scholar 

  23. FitzGeral MC, Neville CE, Mallinson T, Badillo SA, Hynes CK, Tu FF (2011) Pelvic floor muscle examination in female chronic pelvic pain. J Reprod Med 56:117–122

    Google Scholar 

  24. Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC, Vieira M, Hasan W, Bricou A (2006) Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod 21(7):1839–1845

    Article  PubMed  Google Scholar 

  25. Schliep KC, Mumford SL, Peterson CM, Chen Z, Johnstone EB, Sharp HT, Stanford JB, Hammoud AO, Sun L, Buck Louis GM (2015) Pain typology and incident endometriosis. Hum Reprod 30(10):2427–2438. doi:10.1093/humrep/dev147

    CAS  Article  PubMed  Google Scholar 

  26. Travell J, Simons D (1983) The trigger point manual. William & Wilkins, Philadelphia, p 1

    Google Scholar 

  27. Petersen CD, Giraldi A (2008) Should physiotherapy be part of a multidisciplinary treatment for women with chronic pelvic pain? Int J Clin Pract 62(2):174–175

    CAS  Article  PubMed  Google Scholar 

  28. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Arne V, Wein A (2002) The standardisation of terminology of lower urinary tract function: report from the standardisationsub committee of the International Continence Society. Am J Obstet Gynecol 187:116–126

    Article  PubMed  Google Scholar 

  29. Heim LJ (2001) Evaluation and differential diagnosis of dyspareunia. Am Fam Physician 63:1535–1544

    CAS  PubMed  Google Scholar 

  30. Ferrero S, Esposito F, Abbamonte LH, Anserini P, Remorgida V, Ragni N (2005) Quality of sex life in women with endometriosis and deep dispareunia. Fertil Steril 83:573–579

    Article  PubMed  Google Scholar 

  31. Porpora MG, Koninickx PR, Piazze J, Natili M, Colagrande S, Cosmi EV (1999) Correlation between endometriosis and pelvic pain. J Am Assoc Gynecol Laparosc 6(4):429–434

    CAS  Article  PubMed  Google Scholar 

  32. Bellelis P, Dias JA Jr, Podgaec S, Gonzales M, Baracat EC, Abrão MS (2010) Epidemiological and clinical aspects of pelvic endometriosis—a case series. Rev Assoc Med Bras 56(4):467–471

    Article  PubMed  Google Scholar 

  33. Jia SZ, Leng JH, Sun PR, Lang JH (2013) Prevalence and associated factors of female sexual dysfunction in women with endometriosis. Obstet Gynecol 121(3):601–606

    Article  PubMed  Google Scholar 

  34. Tripoli TM, Sato H, Sartori MG, de Araujo FF, Girão MJBC, Schor E (2011) Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis. J Sex Med 8(2):497–503

    Article  PubMed  Google Scholar 

Download references


The authors would like to thank CAPES for their financial support.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ana Paula Santos dos Bispo.

Ethics declarations

Conflict of interest

We declare that we have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

dos Bispo, A.P.S., Ploger, C., Loureiro, A.F. et al. Assessment of pelvic floor muscles in women with deep endometriosis. Arch Gynecol Obstet 294, 519–523 (2016).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Deep endometriosis
  • Pelvic floor muscles
  • Physical therapy
  • Muscle spasm
  • Trigger point
  • Deep dyspareunia