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PHYSIOTHERAPIST
From the Year X axis 1980 to 2019 for the Y axis 20 to 180
Graph of publications about vaginismus and female sexual disorders by years
CAUSES OF VAGINISMUS
Childbirth injuries, such as vaginal tears.
Prior surgery.
Physical psychological and sexual issues.
Bladder infections.
UTI.
Yeast infections.
Anxiety disorders.
Fear of sex or negative feelings about sex, perhaps due to past sexual abuse, rape or trauma.
Hypertonous of pelvic floor muscles.
Types of vaginismus
Vaginismus is classified into two types:
primary vaginismus:
secondary vaginismus:
when vaginal penetration was once achieved, but is no longer possible, potentially due to factors such as gynecologic surgery, trauma, or radiation.
PudendalNeuralgia:
It can cause pain, irritation and spasam of muscles. Sensory symptoms may extend till groin. Abdomen legs and buttocks. Discomfort wearing tight clothes.
Vaginal atrophy:
Lack of estrogen after menopause makes the lining of the vagina thinner and drier (vaginal atrophy).
This condition causes painful sex (dyspareunia). People may have pain from initial penetration throughout the entire experience symptoms of vaginismus.
Inability to have sex or have a pelvic exam due to vaginal muscle spasms or pain.
Painful intercourse.
Assessment by Pelvicfloor rehab Physiotherapist
SUBJECTIVE ASSESSMENT:
Every Assessment starts with taking proper history and asking about the chief complain.
The subjective assessment should include, Name, Age, Occupation, Lifestyle,Habit, Chief complain
History related to childbirth, urine leak, perineal injury, surgery, sexual activity, pelvic organ prolapse should taken in detail.
Any other history related to chronic low back pain especially which is not responding to treatment should also be noted.
OBJECTIVE ASSESSMENT
Posture
Gait
Perineal observation
PERINEAL OBSERVATION
The perineal observation can be further divided into Static observation and Dynamic observation
Observation of skin
Episiotmy
DYNAMIC OBSERVATION
The dynamic observation consists of, -contraction and relaxation of pelvic floor muscles-movement of clitoris
and perineal body, anal wink-observation of PFM during coughing-Bulge, Drop etc. Perineal movement
Contract PFM
Don’t forget to look for accessory muscle movement during contraction and relaxation.
Oxford Grade Scale
Grading according to Het’s SERF Assessment
S= STRENGTH / RELAXATION (+3/-3)
R= REPETITION 10/10
SYMPTOMATIC PENETRATION
GRADE -2
RELAXATION (PAIN, TIGHTNESS, DISCOMFORT OR ANY OTHER SYMPTOM)
PERFECT SCALE
P- Performance
E- Endurance
R- Repetition
F- Fast
Patient Education
Muscle Identification
Movement Awareness
Muscle Activation
Treatment plan
TREATMENT FOR VAGINISMUS DYSFUNCTION
As we have seen earlier the hypertonus dysfunction occurs due to pelvic floor muscle tightness.
So the most important thing in this protocol will be to focus on sustained relaxation of the pelvic floor muscles.
Patient may need some pain relieving treatment and bio feed back for proper understanding of the muscles
IFT & US
IFT can be used for the pain relief as it is used for other areas.
The placement will be two electrodes on the medial 1/3rd of inguinal ligament on each side and other two electrodes near the
ischial tuberosity.
US can be given to the vulvar area or the Mons if they are painful, use the water bag method.
VAGINAL DILATORS
Stretches
• Adductors.
• Hip Flexors.
• Piriformis.
• Hipcurling
• Puppy pose.
• Pigeon pose.
• Lateral stretch.
• Glutei rolls.
• Butterfly stretch.
• Straddle stretch.
• Relaxed squat.
• Spinal twist.
• So a proper stretching of these muscles will help the patient to reduce the heaviness in the whole pelvis..