Department of Obstetrics and Gynecology, Yitzhak Shamir (formerly Assaf Harofe) Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
School of Rehabilitation Sciences, Chair in Women's Health Research, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
Sex Med Rev. 2021 Jan;9(1):76-92. doi: 10.1016/j.sxmr.2020.04.002. Epub 2020 Jul 4.
The assessment of pelvic floor muscle (PFM) overactivity is part of a comprehensive evaluation including a detailed history (medical, gynecological history/antecedent), appraisal of the psychosocial contexts of the patient, as well as a musculoskeletal and a neurological examination.
The aims of this article are to review (i) the assessment modalities evaluating pelvic floor function in women and men with disorders associated with an overactive pelvic floor (OPF), and (ii) therapeutic approaches to address OPF, with particular emphases on sexual pain and function.
We outline assessment tools that evaluate psychological and cognitive states. We then review the assessment techniques to evaluate PFM involvement including digital palpation, electromyography, manometry, ultrasonography, and dynamometry, including an overview of the indications, efficacy, advantages, and limitations of each instrument. We consider each instrument's utility in research and in clinical settings. We next review the evidence for medical, physiotherapy, and psychological interventions for OPF-related conditions.
Research using these assessment techniques consistently points to findings of high PFM tone among women and men reporting disorders associated with OPF. While higher levels of evidence are needed, options for medical treatment include diazepam suppositories, botulinum toxin A, and other muscle relaxants. Effective psychological therapies include cognitive behavioral therapy, couple therapy, mindfulness, and educational interventions. Effective physiotherapy approaches include PFM exercise with biofeedback, electrotherapy, manual therapy, and the use of dilators. Multimodal approaches have demonstrated efficacy in reducing pain, normalizing PFM tone, and improving sexual function. Multidisciplinary interventions and an integrative approach to the assessment and management of OPF using a biopsychosocial framework are discussed.
Although the efficacy of various intervention approaches has been demonstrated, further studies are needed to personalize interventions according to a thorough assessment and determine the optimal combination of psychological, physical, and behavioral modalities. Padoa A, McLean, L, Morin M, et al. The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients. Sex Med 2021;9:76-92.
评估盆底肌（PFM）过度活跃是综合评估的一部分，包括详细的病史（医学、妇科病史/既往史）、评估患者的社会心理背景，以及肌肉骨骼和神经系统检查。
本文的目的是回顾（i）评估患有与过度活跃的盆底相关的疾病的男性和女性的盆底功能的评估方法，以及（ii）治疗过度活跃的盆底的方法，特别强调性疼痛和功能。
我们概述了评估心理和认知状态的工具。然后，我们回顾了评估 PFM 参与的评估技术，包括数字触诊、肌电图、测压法、超声检查和动力测定，包括对每种仪器的适应症、疗效、优点和局限性的概述。我们考虑了每种仪器在研究和临床环境中的效用。接下来，我们回顾了治疗与过度活跃的盆底相关的疾病的医学、物理治疗和心理干预的证据。
使用这些评估技术的研究一致指出，报告与过度活跃的盆底相关的疾病的男性和女性的 PFM 张力较高。虽然需要更高水平的证据，但医学治疗的选择包括安定栓剂、肉毒杆菌毒素 A 和其他肌肉松弛剂。有效的心理治疗包括认知行为疗法、夫妻治疗、正念和教育干预。有效的物理治疗方法包括 PFM 锻炼与生物反馈、电疗、手法治疗和使用扩张器。多模式方法已被证明能有效减轻疼痛、使 PFM 张力正常化和改善性功能。讨论了使用生物心理社会框架对过度活跃的盆底进行综合评估和管理的多学科干预和综合方法。
虽然已经证明了各种干预方法的疗效，但需要进一步的研究来根据全面评估来个性化干预，并确定心理、身体和行为模式的最佳组合。
