Correlação entre a função e tônus da musculatura do assoalho pélvico e queixa de dor durante a relação sexual em mulheres com dor gênito-pélvica/penetração

Abstract

Background: Genito-pelvic pain/penetration disorder (GPPPD) is the term used to define female sexual disorders that encompass conditions such as dyspareunia, vaginismus and vulvodynia, significantly affecting women's quality of life. GPPPD is associated with changes in the pelvic floor muscles (PFM), including increased tone and muscle spasms, which may contribute to pain during sexual intercourse. However, there are still few studies that directly evaluate the relationship between PFM muscle tone and strength and the intensity of muscle pain in women with GPPPD. Objectives: Evaluate the correlation between pelvic floor muscle tone and strength and pain intensity in women with GPPPD. Methods: This is a cross-sectional study that included women over 18 years of age who had already had sexual intercourse and who had genito-pelvic pain/penetration before, during or after sexual intercourse. The assessment of the participants included a physical examination of the PFM with measurement of tone using the Reissing Scale, muscle strength using the modified Oxford Scale and tender points using the Pain Map, using the Visual Analogue Scale (VAS). To assess tender points, points in the region of the right and left obturator internus muscles and the right and left levator ani muscles were palpated. Statistical analysis was performed using the JASP software, with the Shapiro-Wilk test to verify data normality and the Spearman correlation test (p<0.05). Results: Sixty-two women participated in the study (age: 28.26 ± 9.36 years; BMI: 23.67 ± 4.90 kg/m²). The PFM muscle strength was 3.26 ± 1.03 and tone, 0.50 ± 0.74. Correlation analysis showed no relationship between tone and muscle strength and pain intensity in the right and left obturator internus and right and left levator ani muscles (p>0.05). However, there was a moderate positive correlation between pain in the right obturator internus and levator ani (p<0.001, r=0.61), as well as between the first one and the left obturator internus (p<0.001, r=0.49). Positive correlations were also observed between pain in the right and left levator ani (p<0.001, r=0.63) and between the left obturator internus and the left levator ani (p<0.001, r=0.64). Conclusion: The results indicate that there is no correlation between the tone and strength of the PFM and complaint of pain in women with GPPPD. However, the pain appears to be distributed different muscles of the pelvic floor, suggesting that its origin may be multifactorial, involving not only muscular aspects, but also other intrinsic factors and biopsychosocial factors. Implications: A comprehensive clinical approach is needed in the assessment and treatment of pain in women with GPPPD, going beyond the isolated analysis of muscle tone. Future studies should explore other intrinsic and extrinsic factors involved in this condition.