The Pelvic Pain Puzzle: A Case Report on a Physical Therapist’s Role in the Treatment of Dyspareunia

Background: Dyspareunia affects two-thirds of women throughout their lifetime and can be caused by a multitude of diagnoses or musculoskeletal problems including but not limited to chronic pelvic pain, lichen sclerosis, interstitial cystitis/bladder pain syndrome, irritable bowel syndrome, obesity, depression, and anxiety. The purpose of this case report is to demonstrate the complexity of dyspareunia and explore the role of physical therapy in a multifaceted, pelvic health case. It will also show an evidence-based relationship between pelvic diagnoses and dyspareunia as well as pelvic floor physical therapy’s efficacy in treating an area previously managed exclusively by medical interventions. Case Description: A 30-year-old female presenting with chief complaint of dyspareunia as well as bladder dysfunction including pain with storage, high frequency, and urge incontinence. Due to pelvic floor symptoms, patient is struggling to participate in work duties. The patient’s main goal is to become pregnant with her current partner. Intervention: The therapist focused the treatment on internal pelvic floor manual therapy following the Thiele Technique with focus on left obturator internus to reduce pain and urinary symptoms. Additional treatments included neuromuscular re-education, therapeutic activity, and therapeutic exercise. Discussion: Internal pelvic floor manual therapy is among the leading interventions for many of the patient’s pelvic diagnosis. The patient had a significant improvement in symptoms after therapy intervention and home exercise prescription. More pelvic floor research is required to ensure a “gold standard” practice for pelvic floor rehabilitation.