Efeito da adição de dilatadores vaginais à técnica de terapia manual em mulheres com dor gênito pélvica/penetração: ensaio clínico controlado randomizado

Abstract

Introduction: Genito-pelvic/penetration pain has a high prevalence and negatively impacts women's quality of life. Therefore, effective interventions are needed for its treatment. However, few clinical trials with adequate methodological quality have investigated the comparison of physical therapy approaches in women with genito-pelvic/penetration pain. Objective: To compare the effects of physical therapy through manual therapy, with or without the use of vaginal dilators, on sexual function and pain in women with genito-pelvic/penetration pain. Methods: This is a parallel, assessor-, therapist-, and statistician-blinded randomized controlled trial with concealed allocation. Women over 18 years of age who had previously engaged in vaginal penetration and reported genito-pelvic/penetration pain before, during, or after intercourse at least once a week were included. Participants were randomly assigned to one of two groups: manual therapy group (MT) and manual therapy combined with vaginal dilator group (MTD). Both groups received 10-minute treatment sessions, with the MT group receiving 10 minutes of manual therapy and the MTD group receiving 5 minutes of manual therapy and 5 minutes using a vaginal dilator. A total of 10 sessions were conducted, twice a week. Before and after the intervention, participants were assessed for sexual function using the Female Sexual Function Index (FSFI) and were asked about the intensity of pain during their last three penetrative sexual encounters, rated using the Visual Analog Scale. Repeated measures ANOVA followed by Tukey's post hoc test was used for between-group comparisons, with a significance level of 5%. Results: Of the 62 women selected, 31 were randomized to the MT group and 31 to the MTD group. There were no significant intra- or intergroup differences in total FSFI scores or in the domains of desire, arousal, lubrication, orgasm, and satisfaction. The pain domain of the FSFI showed a significant reduction in the MTD group (p=0.037), with no between-group differences after the intervention (p=0.966). Pain reported during sexual intercourse significantly decreased in both groups (p<0.001), with no difference between the groups (p=0.121). These results suggest that both manual therapy and vaginal dilator use may be effective in reducing pain, but there was no significant difference between the approaches. Conclusion: It is concluded that manual therapy, with or without the use of vaginal dilators, was effective in reducing genito-pelvic/penetration pain, with neither intervention proving superior to the other.