Outline of Therapy
The word therapy means “to take care of.” In the context of chronic urogenital pain it means addressing the issue of pain and symptoms, restoring normal function and facilitating greater self-fulfillment and quality of life. Given that each individual presents with a unique history of symptoms, past treatments, personal needs, goals and expectations, therapy is always customized and progress is regularly reviewed. To this end the therapeutic process is divided into three components consisting of assessment, intervention and relapse prevention.
Assessment. As the therapist needs to be familiar with the client’s health history and symptoms the initial assessment includes history taking, reviewing referral letters and completed questionnaires. Next, the client is given a summary of therapy options including duration and frequency of appointments, which, if acceptable, leads to discussion and signing of consent and financial agreement forms. In some cases, either by the client’s choice or the therapist’s decision, no further appointments are scheduled. The clients who choose to proceed progress to a more detailed assessment which consists of postural evaluation, urogenital pain mapping and surface electromyography (SEMG) assessment of pelvic muscle function. Pain mapping consists of a Q-tip test of external urogenital areas, digital palpation of external and internal pelvic muscles and the paraurethral area, with the aim of identifying potential origins of pain, assessing its severity, characteristics and distribution. SEMG consists of using a vaginal or anal probe to assess the functional state of internal pelvic muscles and evaluating their ability to relax and contract appropriately.
Intervention. Based on client history and assessment, therapy consists of three components; myofascial mobilisation, SEMG biofeedback training, and relaxation guidance. The primary focus of the intervention is on manual therapy both during scheduled appointments and client self therapy in between sessions.
Myofascial Therapy. The aim of therapy is to normalize the function of pelvic muscles and its connective tissue (known as fascia). Myofascial therapy focuses on mobilisation of restrictions and contractures. This may involve compressing, stretching, and massaging of external and internal pelvic muscles, correcting posture, and introducing habits that reduce the risk relapse.
SEMG Biofeedback Training & Relaxation. Manual therapy is assisted by the use of biofeedback training which enhances self-regulation of muscle tension and assists with diaphragmatic breathing and relaxation. Clients are also provided with strategies for the management of stress and are counseled in relation to management of symptoms.
Dilators. Dilators may be used to progressively expand the vaginal opening. The use of vaginal dilators is only upon recommendation from a medical practitioner or client request. Dilators are used in conjunction with abdominal breathing exercises and are intended to enhance relaxation and client confidence prior to engaging in intimate sexual activity.
Risks. The above therapeutic interventions are associated with minimal risks. The primary risk is potential discomfort arising from contact with tense and tender pelvic muscles.
Total therapy may require 6 – 12 or more sessions, each session averaging 50 minutes in duration. The number and duration of sessions is dependent on severity of symptoms, individual arrangements, as well as clients’ progress with self-therapy. In some instances intensive therapy may be recommended, and is available through the Adelaide clinic.
Recent trials of therapy focused on peripheral mechanisms of pain and utilising myofascial and biofeedback therapies show promising potential in resolving symptoms of urogenital pain. As a result sufferers should not despair and give up hope.
© Marek Jantos, Sherie Johns & Ewa Baszak-Radomanska
Therapy is only provided on the basis of a written medical referral.