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RESEARCH ARTICLE
Contents Vol 21(5)

Pelvic myofascial pain is associated with restriction of sexual activity in women with pelvic pain: a cross-sectional study

Sara R. Till https://orcid.org/0000-0001-6790-132X A * , Andrew Schrepf B and Sawsan As-Sanie A
+ Author Affiliations
- Author Affiliations

A Department of Obstetrics and Gynecology, University of Michgan, Ann Arbor, MI, USA.

B Department of Anesthesiology, University of Michgan, Ann Arbor, MI, USA.

* Correspondence to: tillsa@med.umich.edu

Handling Editor: Darren Russell

Sexual Health 21, SH24144 https://doi.org/10.1071/SH24144
Submitted: 13 July 2024  Accepted: 19 September 2024  Published: 7 October 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing

Abstract

Background

Dyspareunia and restriction of sexual activity are often reported by patients with chronic pelvic pain, but less is known about which conditions or factors contribute most to these symptoms.

Methods

This is a cross-sectional study of consecutive new patients who presented to a chronic pelvic pain and endometriosis referral clinic between January 2013 and December 2015. Patients completed a detailed questionnaire prior to their first visit and underwent a comprehensive standardised pelvic examination at their first visit. Patients were grouped according to description of sexual activity as ‘normal activity without pain’, ‘normal activity but painful’, ‘severely restricted by pain’, or ‘absent due to pain.’ Primary outcome was restriction of sexual activity due to pain. Multinomial logistic regression was performed with ‘normal activity without pain’ group as reference category and adjusted for age, depression, history of endometriosis, and pelvic myofascial pain.

Results

Over half of the 187 patients with chronic pelvic pain described severely restricted (n = 75, 40.1%) or absent (n = 21, 11.2%) sexual activity due to pain. Pelvic myofascial pain was highly prevalent in this population and pelvic myofascial tenderness score was associated with higher odds of sexual activity that was severely restricted by pain (OR 1.05, 95% CI 1.01–1.09, P = 0.006) or absent due to pain (OR 1.09, 95% CI 1.04–1.13, P < 0.001). History of endometriosis and depression were not independently associated with restriction of sexual activity due to pain.

Conclusion

Dyspareunia and sexual dysfunction are highly prevalent among patients with chronic pelvic pain, and pelvic myofascial pain is strongly associated with restriction of sexual activity due to pain.

Keywords: chronic pelvic pain, depression, dyspareunia, endometriosis, high-tone pelvic floor dysfunction, myofascial pelvic pain syndrome, pelvic floor tenderness, sexual dysfunction.

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