How can the improvement of
vaginal dryness and dyspareunia be explained?
Can it be due to
blood flow of
pelvic floor muscle
Blood flow of the
vulvovaginal tissue was measured with doppler
ultrasound. The main vessels, the internal pudendal artery and the dorsal clitoral artery were checked. The blood flow was measured three times at rest and after three pelvic floor muscle
contractions. The pelvic floor muscle
function was measured with an intravaginal dynamometric speculum and the Vaginal Atrophy
Indexwas used to assess genitourinary
After the 12 week pelvic
floor muscle training program the vulvovaginal blood flow increased significantly in all arteries. The relaxation of the pelvic floor muscle after a contraction was significantly faster. The
overall Vaginal Atrophy Index and especially the items on skin elasticity and turgor and
increase in vaginal mucosa thickness as well as the introitus width improved significantly.
Interestingly the pelvic
floor muscle strength did not improve significantly (p=0.051). The authors hypothesise that this might be due to the fact that the women in this study can have a lowered tone of the pelvic floor
muscles because of their menopausal state but women can also have a heightened tone due to dyspareunia and because of the small sample size significance was not reached.
The results of this study
are very interesting and I hope more high quality research in this field (to test the reproducibility of the results) will be done to improve our understanding of the effect of pelvic floor
muscle training on symptoms of genitourinary syndrome. I am waiting for the first randomized controlled trial on this subject with hopefully a longer follow-up period as well. A randomized
controlled trial can also differentiate between baseline variables like pelvic floor muscle tone (heightened or lowered) and the results on genitourinary syndrome.