Treatment for Pelvic Floor Myalgia and Myofascial Pelvic Pain: A Systematic Review

Abstract

Introduction Pelvic floor myalgia is characterized by muscular tension, tenderness and trigger points of the pelvic floor muscles and connective tissue. Its prevalence varies from 14-78%. Our aim was to review treatment interventions for adult women with pelvic floor myalgia Methods A systematic review of prospective trials was conducted in MEDLINE (Ovid/PubMed), EMBASE, Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov. Studies published up until March 2020 were included. After duplicates were removed, 7,711 studies were screened and 992 full texts were reviewed for final inclusion of randomized control trials (RCT) only. To meet inclusion criteria, study participants needed to have pelvic floor myalgia, hypertonicity or pain determined by a physical exam. All interventions were included. Results After final data extraction, 18 studies met inclusion criteria, which included 1043 participants. Most studied interventions were pelvic floor physical therapy (4 studies, 218 participants) and pelvic floor botulinum A toxin injections (4 studies, 281 participants). Other interventions included vaginal diazepam (3 studies, 112 participants), oral desipramine/local lidocaine (1 study, 133 participants), cognitive behavioral therapy (1 study, 117 participants), hypnotherapy (1 study, 36 participants), local anesthetic trigger point injections (1 study, 29 participants), and oxytocin nasal spray (1 study, 21 participants). Conclusions Many studies showed a placebo effect possibly indicating that simple acknowledgement of pain symptoms with a treatment plan can improve pain. Physical therapy showed significant improvement in pain and sexual functioning compared to controls. Botulinum toxin A was not proven to be beneficial for pelvic floor myalgia and hypertonicity