This systematic review aimed to estimate the effects of physiotherapy compared to pharmacological, psycho-behavioural or no intervention on intensity of perceived pain, sexual function and quality of life in women with dyspareunia.
Five databases were searched from inception to May 2023. Included designs were non-randomised trials, randomised trials and quasi-randomised trials. Studies included women with dyspareunia and compared groups receiving at least one physiotherapy intervention (electrotherapy, massage and exercise modalities) with those receiving pharmacological treatment, psycho-behavioural interventions, or no-intervention. Outcomes of interest were intensity of pain, sexual function and quality of life. Risk of Bias assessment was performed used the ROBINS-I tool for non-randomized trials and the Cochrane Risk of Bias 1 tool for randomized trials. Meta-analyses using random-effects models assessed standardized mean differences (SMD) and 95% confidence intervals (CI). GRADE was applied to each meta-analysis to evaluate the certainty of evidence.
This review included 19 studies; eight randomised trials, two quasi-randomised trials, nine non-randomised studies. Physiotherapy interventions were multiple physiotherapy treatments (n=6), electrotherapy (n=5), pelvic floor muscle training (n=2), Thiele’s massage (n=3), interdisciplinary interventions or pelvic floor muscle training (n=2), extracorporeal shock-wave therapy (n=1). Interventions were 4 weeks to 1 year with at least 1 session per week (when the number of sessions were reported). Only randomised trials were included in the meta-analysis and GRADE synthesis for pain (3 trials, 207 participants), sexual function (2 trials, 373 participants) and quality of life (2 trials, 64 participants).
Compared to control or no intervention, there was moderate certainty evidence that physiotherapy management (electrotherapy and electrotherapy plus pelvic floor muscle training) improved pain (SMD -4.4, 95% CI -7.9 to -1.0). There was low certainty evidence that physiotherapy management (electrotherapy and electrotherapy plus kinesiotherapy) improved quality of life (SMD -0.38 95% CI: -0.74 to -0.03) but did not improve sexual function (SMD 2.37 95% CI: -1.43 to 6.17) compared to control or no intervention. Adverse events were not reported.
The review concluded that physiotherapy was effective for reducing pain in women with dyspareunia when compared to control interventions. Physiotherapy was effective for improving quality of life and ineffective for improving sexual function but there is low certainty evidence. Future research is needed to improve the certainty of the evidence.
Fernandez-Perez P, Leiros-Rodriguez R, Marques-Sanchez MP, Martinez-Fernandez MC, de Carvalho FO, Maciel LYS. Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis. BMC Womens Health 2023; 23: 387. DOI: doi.org/10.1186/s12905-023-02532-8
