Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101, Cidade Universitária, Campinas, SP, Brazil.
Department of Physiotherapy, Unimetrocamp University Center, Campinas, Brazil.
Int Urogynecol J. 2021 May;32(5):1087-1096. doi: 10.1007/s00192-021-04725-x. Epub 2021 Feb 27.
Female myofascial pain (MFP) of the pelvic floor muscles (PFM) is a subtype of chronic pelvic pain associated with urinary, anorectal, and sexual symptoms, such as dyspareunia. Treatment remains poorly discussed, and we hypothesized that different treatments could improve outcomes versus placebo or no treatment.
A systematic review (CRD 42020201419) was performed in June 2020 using the following databases: PubMed, Cochrane Library, Web of Science, Embase, Scopus, BVSalud, Clinicaltrials.gov , and PEDro, including randomized clinical trials related to MPF of PFM. Primary outcome was pain after treatment, and secondary outcomes were quality of life and sexual function. Risk of bias and quality of evidence (GRADE criteria) were evaluated. Meta-analysis for continuous variables was performed (mean difference between baseline and treatment and post-treatment mean between groups).
Five studies were included (n = 218). Final mean VAS score (GRADE: very low) after 4 weeks of treatment (p = 0.14) and the mean difference from baseline and 4 weeks (p = 0.66) between groups were not different between the intervention and control groups. Quality of life according to the SF-12 questionnaire (GRADE: very low) followed the same pattern. However, sexual function (GRADE: low) according to the total FSFI score (MD = -5.07 [-8.31, -1.84], p < 0.01, i = 0%) and the arousal, orgasm, and pain domains improved in the intervention groups when the mean difference from baseline and 4 weeks was compared with controls.
Pain and quality of life after 4 weeks of heterogeneous intervention differed between the intervention and control groups in sexual function: FSFI in studies improved in almost all domains. VAS (in three studies) and SF-12 (in two studies) failed to demonstrate differences.
女性盆底肌肉的肌筋膜疼痛（MFP）是一种与尿、肛肠和性症状相关的慢性盆腔疼痛的亚型，如性交疼痛。治疗方法仍未得到充分讨论，我们假设不同的治疗方法可能会改善与安慰剂或不治疗相比的结果。
2020 年 6 月，我们使用以下数据库进行了系统评价（CRD42020201419）：PubMed、Cochrane 图书馆、Web of Science、Embase、Scopus、BVSalud、Clinicaltrials.gov 和 PEDro，包括与盆底肌肉 MFP 相关的随机临床试验。主要结局是治疗后的疼痛，次要结局是生活质量和性功能。评估了偏倚风险和证据质量（GRADE 标准）。对连续变量进行了荟萃分析（基线和治疗之间的平均差异以及组间治疗后平均差异）。
纳入了五项研究（n=218）。治疗 4 周后最终平均 VAS 评分（GRADE：极低）（p=0.14）和组间从基线到 4 周的平均差异（p=0.66）在干预组和对照组之间没有差异。SF-12 问卷的生活质量（GRADE：极低）也呈现出相同的模式。然而，根据总 FSFI 评分（MD=-5.07[-8.31,-1.84]，p<0.01，I=0%）和性欲、高潮和疼痛域，性功能（GRADE：低）在干预组中改善与对照组相比，从基线到 4 周的平均差异。
4 周不同干预后的疼痛和生活质量在性功能方面在干预组和对照组之间存在差异：研究中的 FSFI 在几乎所有领域都有所改善。VAS（在三项研究中）和 SF-12（在两项研究中）未能显示差异。
