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Physiotherapy Management of Female Sexual Dysfunction-FSD PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Physiotherapy management of female sexual dysfunction (FSD)" by Holly Davies.

This medical PowerPoint presentation discusses how physiotherapy can play an important role in the management of female sexual dysfunction (FSD), which can encompass a variety of conditions, including but not limited to vaginal dryness, painful intercourse, decreased libido, and difficulty achieving orgasm.

Tags : female sexual dysfunction, vaginal dryness, painful intercourse, decreased libido, difficulty achieving orgasm

Published on : Mar 28, 2023 | Views : 925 | Downloads : 1

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Slide 1-

Holly Davies Highly specialist pelvic health physiotherapist Feb 2019 Physiotherapy management of female sexual dysfunction (FSD)
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Learning objectives To be aware of the most common female sexual dysfunctions (FSD) To understand the role of physiotherapy in the management of FSD, specifically genito-pelvic pain/penetration disorders To understand the importance of a biopyschosocial approach to treatment
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What is sexual health? “…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” (WHO, 2006a)
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What is normal in the UK? NATSAL 3 (National Survey of Sexual Attitudes and Lifestyles UK) Population study UK -2013 15,000 people Ages 16-74 Average frequency of sex = x3 per month 70-80% of women will not orgasm with penetration Reduced sexual function associated with depression, increasing age, poor health and unemployment
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‘Any specific difficulties in the last year lasting 3 months or more? Women 35% lacked interest in sex for at least 3 months in past year (only 10% distressed by this) 12% lacked enjoyment in sex 16% difficulty in reaching climax 7.5% felt physical pain as a result of sex 13% uncomfortable dry vagina
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How good are we at talking about sex? The PATIENT The CLINICIAN/GP Study 2009: GPs ask patients <25% of the time Secondary care – asked only 50% of the time ?this may be better now ?due to lack of time and training Anybody presenting with period problems, pelvic pain, other gynaecology conditions should be asked about sex routinely. Using a relaxed open question ‘how's sex?’
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Definitions of FSD Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria (American Psychiatric Association) DSM-5 (May 2013): Female sexual interest/ arousal disorder Female orgasmic disorder Genito-pelvic pain/ penetration disorder (merged dyspareunia and vaginismus) Previously DSM 4 (1994): Dyspareunia – pain during penetration/ intercourse, which could be superficial or deep Vaginismus – involuntary vaginal muscle spasms, which were strong enough to interfere with or prevent intercourse/ penetration
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Genito-pelvic pain/ penetration disorder (GPPPD) Defined by DSM-5 as at least 6 months persistent or recurrent difficulties in the following criteria: Vaginal penetration during intercourse Marked vulvo-vaginal or pelvic pain during vaginal intercourse or penetration attempts Marked fear and anxiety about vulvo-vaginal or pelvic pain in anticipation of, during or as a result of vaginal penetration Marked tensing and tightening of the pelvic floor muscles during attempted vaginal penetration Diagnosis of exclusion
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Vulvodynia Definition: ‘ Vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinical identifiable, neurological disorder’ (ISSVD, 2003) Sub-types: Generalised a. Provoked – sexual, non sexual, both b. Unprovoked c. Mixed 2. Localised (includes vestibulodynia, clitorodynia and hemivulvodynia) a. Provoked – sexual, non sexual (tampon), both b. Unprovoked c. Mixed Diagnosis of exclusion (2015 Consensus Terminology of Persistent Vulvar Pain and Vulvodynia)
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Pain related to specific conditions Superficial/ vulvar Infectious – candida, herpes simplex virus Inflammatory/dermatologic – lichens planus, lichens sclerosus, vulvar dermatitis Hormonal – vulvo-vaginal atrophy Trauma - post operative delivery, perineal trauma, radiotherapy, FGM Structural – septum, congenital Neurological - neuropathic pain, neurological disease Malignancy (vaginal or vulval neoplasia) Deep Non-gynaecological (IBS, inflammatory bowel disease, UTI) Pelvic congestion syndrome Endometriosis Adnexal or pelvic pathology (cysts, fibroids, pelvic malignancies) Infectious - PID Iatrogenic - vaginal shortening or narrowing, post radiotherapy changes Chronic pelvic pain Pelvic floor dysfunction (mechanical, anatomical factors, retroversion, prolapse
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Correct terminology of sexual/genital conditions: Conforti, Celine. (2017). Genito-Pelvic Pain/Penetration Disorder (GPPPD): An Overview of Current Terminology, Etiology, and Treatment. University of Ottawa Journal of Medicine. 7. 48. 10.18192
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Vulvodynia and GPPPD: contributing factors … Psychosocial: Anxiety/ fear/ behavioural avoidance Depression/ OCD Lack of arousal/desire Negative expectations Partner’s support and understanding/ relationship Cultural background Past relationships, sexual education and knowledge of anatomy Previous physical +/- sexual abuse Previous trauma (eg: traumatising gynae procedure, early sexual experiences) Biological: Infections Lack of lubrication – vaginal dryness/atrophy Chemical irritation – soaps, douches, allergy Recurrent vulvo-vaginal candida Repeated local anti-fungal treatments Local treatment for HPV Immunological Genetic link to develop chronic inflammatory conditions Hormonal influence – combined oral contraceptive pill Genital surgery – eg: episiotomy, perineal tear Often complex and multifactorial
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Physiotherapy Assessment: Subjective assessment using open questions: History of present condition Pain – where, when, agg’s, eases, VAS Sexual function – partners current and previous, first sexual experience, any previous trauma, self play, arousal/desire, vaginal dryness Bladder and bowel function Gynae history – any UTI’s, vaginal infections, thrush, STI’s, smear results, menstrual cycle, contraception Obstetric history – type of delivery, baby weight’s Objective assessment: LISTEN LOOK FEEL
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Physiotherapy treatment Education – anatomy, pain, sex function Vulvar care advice Self exploration/ desensitisation with fingers or dilators – reducing fear and pain Pelvic floor muscle release/ manual therapy/ pelvic floor awareness – reducing tension and tone Pelvic stretches Breathing techniques Relaxation/ mindfulness Graded exposure/ vaginal trainers/ wands Acupuncture/ dry needling
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Research:Bergeron et al 2002 A retrospective study evaluated the effectiveness of physical therapy in relieving painful intercourse and improving sexual function in women diagnosed with vulvar vestibulitis (PVD) 35 women with PVD took part in a physical therapy program for an average of 7 sessions Results: 51.4% of women with PVD had complete or great improvement and 20% moderate improvement to pain at follow up Average coital pain rating decreased from 8.2 to 3.9 after treatment
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MDT - biopsychosocial approach CBT – explore women’s thoughts, emotions, behaviours and relationship dynamics associated with the experiences of sexual pain Psychosexual counselling/ sex therapy– ideally involving partner. Sensate focus programmes. Medication – antidepressants (amitriptyline) anticonvulsants (gabapentin, pregablin) topical (lidocaine) – one study demonstrated only 20% improvement to pain topical oestrogen – lack of evidence Botox – several small studies demonstrate efficacy, no RCT’s to confirm Surgery – vulvar vestibulectomy
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Useful patient resources Websites: www.bssvd.org www.vulvalpainsociety.org www.omgyes.com www.vaginismus.org 2. Books Wonder down under Anatomy of arousal Heal pelvic pain 3. Apps Headspace Finding peace in a frantic world Calms 4. Dilators/wands/sex toys – Sh!, Love honey, Soul source
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Other useful pelvic health physiotherapy resources Other useful pelvic health physiotherapy resources: POGP leaflets - https://pogp.csp.org.uk/publications Including: Pregnancy related pelvic girdle pain Exercise and advice after pregnancy Pelvic floor muscle exercises Promoting continence with physiotherapy Fit for future Fit for birth Fit for pregnancy Fit following surgery
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References WHO 2006a NATSAL 3 (National Survey of Sexual Attitudes and Lifestyles UK) 2013 Bornstein, Jacob, Goldstein, Andrew, Stockdale, Colleen K. et al (2016). Consensus Terminology of Persistent Vulvar Pain and Vulvodynia. Obstetrics & Gynecology: Volume 127 - Issue 4 - p 745–751. Conforti, Celine. (2017). Genito-Pelvic Pain/Penetration Disorder (GPPPD): An Overview of Current Terminology, Etiology, and Treatment. University of Ottawa Journal of Medicine. 7. 48. 10.18192. Nikki M W Lee, Adam D Jakes, Jillian Lloyd, Leila C G Frodsham. (2018) Dyspareunia. BMJ 2018; 361 Bergeron S, Brown C, Lord MJ, Oala M, Binik YM, Khalifé S. (2002) Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J Sex Marital Ther. 2002 May-Jun;28(3):183-92. Foster DC, Kotok MB, Huang L, et al. Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2010;116(3):583-93. Micheletti L, Radici G, Lynch PJ (2015) Is the 2003 ISSVD terminology and classification of vulvodynia up-to-date? A neurobiological perspective. J Obstet Gynaecol. 2015;35(8):788-92.