Department of Physiotherapy, Monash University, Melbourne, Victoria 3199, Australia.
Department of Physical Therapy, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
J Sex Med. 2023 Aug 25;20(9):1206-1221. doi: 10.1093/jsxmed/qdad089.
The association between pelvic pain and pelvic floor muscle (PFM) tone in women with persistent noncancer pelvic pain (PNCPP) is unclear.
To synthesize the evidence of the association between pelvic pain and PFM tone in women with PNCPP.
A systematic review was conducted via MEDLINE, Emcare, Embase, CINAHL, PsycINFO, and Scopus to identify relevant studies. Studies were eligible if pelvic pain and PFM tone outcome measures were reported among women aged >18 years. The National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was used to assess study quality. Studies were pooled by assessment of PFM tone via a random effects model. Associations between the presence of pelvic pain and PFM tone were assessed with odds ratio (OR), while linear associations were assessed with Pearson or Spearman correlation.
Pelvic pain measures (intensity, threshold, and frequency) and resting PFM tone in women with PNCPP, as evaluated by any clinical assessment method or tool.
Twenty-four studies were included in this review. The presence of pelvic pain was significantly associated with increased PFM tone as assessed by digital palpation (OR, 2.85; 95% CI, 1.66-4.89). Pelvic pain intensity was inversely but weakly associated with PFM flexibility when evaluated through dynamometry (r = -0.29; 95% CI, -0.42 to -0.17). However, no significant associations were found between pelvic pain and PFM tone when measured with other objective assessment methods.
Pelvic pain and increased PFM tone may not be directly associated; alternatively, a nonlinear association may exist. A range of biopsychosocial factors may mediate or moderate the association, and clinicians may need to consider these factors when assessing women with PNCPP.
This review was reported according to the PRISMA guidelines. All possible findings from relevant theses and conference abstracts were considered in our search. However, nonlinear associations between pelvic pain and increased PFM tone were not assessed as part of this review.
Pelvic pain may be linearly associated with increased PFM tone and decreased PFM flexibility when measured with digital palpation or dynamometry; however, this association was not observed when other aspects of PFM tone were assessed through objective methods. Future studies are required using robust assessment methods to measure PFM tone and analyses that account for other biopsychosocial factors that may influence the association.
持续性非癌性盆腔疼痛（PNCPP）女性的盆腔疼痛与盆底肌（PFM）张力之间的关系尚不清楚。
综合 PNCPP 女性盆腔疼痛与 PFM 张力关系的证据。
通过 MEDLINE、Emcare、Embase、CINAHL、PsycINFO 和 Scopus 进行系统综述，以确定相关研究。如果研究报告了年龄>18 岁的女性的盆腔疼痛和 PFM 张力结局测量值，则符合纳入标准。采用美国国立心肺血液研究所的观察性队列和横断面研究质量评估工具评估研究质量。通过随机效应模型评估 PFM 张力评估的研究进行汇总。使用比值比（OR）评估盆腔疼痛存在与 PFM 张力之间的关联，使用皮尔逊或斯皮尔曼相关系数评估线性关联。
通过任何临床评估方法或工具评估 PNCPP 女性的盆腔疼痛测量值（强度、阈值和频率）和静息 PFM 张力。
本综述纳入了 24 项研究。数字触诊评估时，盆腔疼痛的存在与 PFM 张力增加显著相关（OR，2.85；95%CI，1.66-4.89）。通过测力评估时，盆腔疼痛强度与 PFM 灵活性呈负相关，但相关性较弱（r=-0.29；95%CI，-0.42 至-0.17）。然而，当使用其他客观评估方法测量时，未发现盆腔疼痛与 PFM 张力之间存在显著关联。
盆腔疼痛和 PFM 张力增加可能没有直接关联；或者可能存在非线性关联。一系列生物心理社会因素可能会调节或调节这种关联，临床医生在评估患有 PNCPP 的女性时可能需要考虑这些因素。
本综述按照 PRISMA 指南进行报告。在我们的搜索中考虑了相关论文和会议摘要中所有可能的发现。但是，作为本综述的一部分，没有评估盆腔疼痛和增加的 PFM 张力之间的非线性关联。
当使用数字触诊或测力评估时，盆腔疼痛可能与 PFM 张力增加和 PFM 灵活性降低呈线性相关；然而，当使用其他客观方法评估 PFM 张力的其他方面时，未观察到这种关联。需要使用稳健的评估方法来测量 PFM 张力，并进行分析，以考虑可能影响这种关联的其他生物心理社会因素。
