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Changes in pelvic floor morphometry and muscle function after multimodal physiotherapy for gynaecological cancer survivors suffering from dyspareunia: a prospective interventional study

  • Marie-Pierre Cyr
    Affiliations
    School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec, J1H 5N4, Canada

    Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec, J1H 5H3, Canada
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  • Chantale Dumoulin
    Affiliations
    School of Rehabilitation, Faculty of Medicine, University of Montreal, 7077 Park Avenue, Montreal, Quebec, H3N 1X7, Canada

    Research Center of the Institut Universitaire de Gériatrie de Montréal, 4545 Queen Mary, Montreal, Quebec, H3W 1W6, Canada
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  • Paul Bessette
    Affiliations
    Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec, J1H 5H3, Canada

    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec, J1H 5N4, Canada
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  • Annick Pina
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, University of Montreal, PO Box 6128 Centre-Ville Station, Montreal, Quebec, H3C 3J7, Canada

    Research Center of the Centre Hospitalier de l’Université de Montréal: 900 St Denis St, Montreal, Quebec, H2X 0A9, Canada
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  • Walter Henry Gotlieb
    Affiliations
    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, McGill University, 1001 Decarie Blvd, Montreal, Quebec, H4A 3J1, Canada

    Lady Davis Institute of the Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada
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  • Korine Lapointe-Milot
    Affiliations
    Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec, J1H 5H3, Canada

    Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec, J1H 5N4, Canada
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  • Marie-Hélène Mayrand
    Affiliations
    Research Center of the Centre Hospitalier de l’Université de Montréal: 900 St Denis St, Montreal, Quebec, H2X 0A9, Canada

    Departments of Obstetrics and Gynecology and Social and Preventive Medicine, Faculty of Medicine, University of Montreal, PO Box 6128, Centre-ville Station, Montreal, Quebec, H3C 3J7, Canada
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  • Mélanie Morin
    Correspondence
    Corresponding author at: Department School of Rehabilitation, Faculty of Medicine and Health Sciences, Institution University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec, J1H 5N4, Canada.
    Affiliations
    School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec, J1H 5N4, Canada

    Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec, J1H 5H3, Canada
    Search for articles by this author
Published:September 30, 2021DOI:https://doi.org/10.1016/j.physio.2021.09.003

      Abstract

      Objective

      To investigate the changes in pelvic floor morphometry and muscle function after multimodal pelvic floor physiotherapy treatment in gynaecological cancer survivors suffering from painful intercourse (dyspareunia).

      Design

      Prospective interventional study.

      Setting

      Three university hospitals.

      Participants

      Thirty-one gynaecological cancer survivors with dyspareunia.

      Intervention

      The treatment consisted of 12 weekly sessions of physiotherapy combining education, pelvic floor muscle exercises with biofeedback, manual therapy and home exercises.

      Main outcome measures

      Women were assessed at baseline and post-treatment. Pelvic floor morphometry was evaluated at rest and on maximal contraction by measuring bladder neck position, anorectal and levator plate angles as well as levator hiatal dimensions with three-dimensional/four-dimensional transperineal ultrasound imaging. Pelvic floor muscle function was evaluated by measuring passive forces (muscle tone measure), flexibility, stiffness, strength, coordination and endurance with an intra-vaginal dynamometric speculum.

      Results

      Significant changes in pelvic floor morphometry and muscle function were found post-treatment. The parameters assessing the changes from rest to maximal contraction significantly improved (e.g., mean change of levator hiatal area narrowing 14 %, 95% CI 11 to 18, Cohen’s d effect size 1.48)), supporting the hypothesis of decreased muscle tone and improved muscle contractility following treatment. Women also presented with a significant decrease in tone (mean change -0.4 N, 95% CI -0.7 to -0.1, Cohen’s d effect size 0.57) and stiffness (mean change -0.1 N/mm, 95% CI -0.2 to -0.1, Cohen’s d effect size 0.59), as well as significant improvements in flexibility (mean change 9.0 mm, 95% CI 5.8 to 12.2, Cohen’s d effect size 1.08), coordination (mean change 3 rapid contractions, 95% CI 2 to 4, Cohen’s d effect size 0.85) and endurance (mean change 683 %*s, 95% CI 388 to 978, Cohen’s d effect size 0.90).

      Conclusion

      Our findings suggest significant improvements in pelvic floor morphometry and muscle function after a multimodal physiotherapy treatment in gynaecological cancer survivors with dyspareunia. These effects may represent key treatment mechanisms to reduce dyspareunia, supporting the rationale for multimodal physiotherapy in this population.

      Clinical trial registration number (ClinicalTrials.gov)

      NCT03935698

      Keywords

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