Abstract
Genital-pelvic pain / penetration disorder (DGPP) includes vaginismus, dyspareunia and vulvodynia, where the following symptoms are present: Presence of fear or anxiety related to vulvovaginal or pelvic pain in anticipation, during or as a result of vaginal penetration, in addition to the presence of tension or hardening of the pelvic floor muscles during the attempt of vaginal penetration. Adequate sexual function is considered an important factor for quality of life, being recognized by WHO (World Health Organization) regarding the presence of sexual dysfunction as a public health problem, recommending its investigation for causing important changes in quality of life and in the relationship with your partner. It is identified that the role of the physiotherapist becomes relevant in the process of identification and rehabilitation of genito-pelvic pain, justifying the importance of studies on this topic. In order to analyze the role of the physiotherapist in the treatment of pelvic genital pain / penetration with a focus on the approach of manual therapy in women at menacme, a narrative review of the literature was carried out, where 17 articles were used as a basis for research and data collection. During the analysis of the articles, it was defined that DSFs tend to appear in the female fertile phase, causing pain and discomfort. In the reviews covered in this study, it was analyzed that DGPP is a complex syndrome in which the sensation and intensity of pain are felt in different places. With this the diagnosis becomes difficult taking into account the shame and / or blocking of the woman in reporting a sexual complaint. Through a physical therapy assessment, in order to check the tone and function of the pelvic floor muscles, the existence and location of tender points, as well as the understanding of voluntary contractions and rests of these muscles, a therapeutic planning with the use of interventions is outlined. specific measures in self-relaxation and anxiety control techniques, improving body awareness. It is concluded that there is effectiveness in exploring self-knowledge to improve the quality of life of women who suffer from this problem, providing positive results in a short period, thus contributing to the improvement of the sexual function of women with DSFs (Female Sexual Dysfunctions).
References
AMERICAN PSYCHIATRIC ASSOCIATION. Diagnostic and Statistical Manual of Mental Disorders (DSM-5).5th ed. Washington, DC: APA; 2013.
BASILIO, Bianca Natani; RIBEIRO, Vanessa Veis; PEREIRA, Eliane Cristina; et al. Autoavaliação vocal de mulheres na menopausa. Revista CEFAC, v. 18, n. 3, p. 649–656, 2016. Disponível em: <https://www.scielo.br/scielo.php?Pid=S1516-18462016000300649&script=sci_abstract&tlng=pt>. Acesso em: 09 de Maio. 2020.
BERGHMANS, Bary. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. International Urogynecology Journal, v. 29, n. 5, p. 631–638, 2018. Disponível em: <https://pubmed.ncbi.nlm.nih.gov/29318334/>. Acesso em: 05 de Maio. 2020.
BORNSTEIN, Jacob; GOLDSTEIN, Andrew T.; STOCKDALE, Colleen K.; et al. 2016 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. Journal of Lower Genital Tract Disease, v. 20, n. 2, p. 126–130, 2016. Disponível em: <https://3b64we1rtwev2ibv6q12s4dd-wpengine.netdna-ssl.com/wp-content/uploads/2015/09/consensus-terminology-of-Vulvar-Pain-V5.pdf>. Acesso em: 18 de Abril. 2020.
BRASIL, Ana Patricia Avancini; ABDO, Carmita Helena Najjar. Transtornos sexuais dolorosos femininos. Revista Diagnóstico & Tratamento, São Paulo, v. 21, n. 2, p. 89-92, 2016. Disponível em: < http://www.apm.org.br/imagens/Pdfs/revista-159.pdf >.
CREFITO-10: Fisioterapia na Saúde da Mulher. Crefito10. Disponível em: <http://www.crefito10.org.br/conteudo.jsp?idc=393>. Acesso em: 20 de Maio. 2020.
FEDERAÇÃO BRASILEIRA DAS ASSOCIAÇÕES DE GINECOLOGIA E OBSTETRÍCIA (FEBRASGO). Dor na genitália e na relação sexual. Febrasgo. Disponível em: <https://www.febrasgo.org.br/pt/noticias/item/146-dor-na-genitalia-e-na-relacao-sexual-2017?highlight=WyJ2dWx2b2RcdTAwZWRuaWEiXQ==>. Acesso em: 03 de Junho. 2020.
GHADERI, Fariba; BASTANI, Parvin; HAJEBRAHIMI, Sakineh; et al. Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial. International Urogynecology Journal, v. 30, n. 11, p. 1849–1855, 2019. Disponível em: <https://pubmed.ncbi.nlm.nih.gov/31286158/>. Acesso em: 28 de Maio. 2020.
HEIM LJ. Evaluation and differential diagnosis of dyspareunia. American family physician, v. 63, n. 8, 2020. Disponível em: <https://pubmed.ncbi.nlm.nih.gov/11327429/>. Acesso em: 29 de Maio. 2020.
LAHAIE, Marie-Andrée; AMSEL, Rhonda; KHALIFÉ, Samir; et al. Can Fear, Pain, and Muscle Tension Discriminate Vaginismus from Dyspareunia/Provoked Vestibulodynia? Implications for the New DSM-5 Diagnosis of Genito-Pelvic Pain/Penetration Disorder. Archives of Sexual Behavior, v. 44, n. 6, p. 1537–1550, 2015. Disponível em: <https://pubmed.ncbi.nlm.nih.gov/25398588/>. Acesso em: 03 de Junho. 2020.
LARA, Lúcia Alves da Silva; SILVA, Ana Carolina Japur de Sá Rosa e; ROMÃO, Adriana Peterson Mariano Salata; et al. Abordagem das disfunções sexuais femininas. Revista Brasileira de Ginecologia e Obstetrícia, v. 30, n. 6, p. 312–321, 2008. Disponível em: <https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032008000600008&lng=en&nrm=iso&tlng=pt>. Acesso em: 18 de Maio. 2020.
LAWSON, Samantha; SACKS, Ashley. Pelvic Floor Physical Therapy and Women’s Health Promotion. Journal of Midwifery & Women’s Health, v. 63, n. 4, p. 410–417, 2018. Disponível em: <https://pubmed.ncbi.nlm.nih.gov/29778086/>. Acesso em: 20 de Junho. 2020.
MENDONÇA, S., & VOLPON BERTO, I. (2021). Covid-19 and the increase of the violence against women in Brazil: overcoming machine culture. Journal of Gender and Interdisciplinarity, 2(03). Disponível em https://doi.org/10.51249/gei02.03.2021.344, acesso em 10/10/2021.
MORRIS, Edward; MUKHOPADHYAY, Sambit. Dyspareunia in gynecological practice. Current Obstetrics & Gynecology, v. 16, n. 4, p. 226–233, 2006. Disponível em: <https://www.sciencedirect.com/science/article/abs/pii/S0957584706000576?via%3Dihub>. Acesso em: 28 de Maio. 2020.
PAZMANY, Els; LY, Huynh Giao; AERTS, Leen; et al. Brain responses to vestibular pain and its anticipation in women with Genito-Pelvic Pain/Penetration Disorder. NeuroImage: Clinical, v. 16, p. 477–490, 2017. Disponível em: <https://pubmed.ncbi.nlm.nih.gov/28932680/>. Acesso em: 25 de Maio. 2020.
RIBEIRO, Bárbara; MAGALHÃES, Ana Teresa; MOTA, Ivone. Disfunção sexual feminina em idade reprodutiva - Prevalência e fatores associados. Revista Portuguesa de Clínica Geral, v. 29, n. 1, p. 16–24, 2013. Disponível em: <https://www.rpmgf.pt/ojs/index.php/rpmgf/article/view/11044>. Acesso em: 11 de Maio. 2020.
SILVA, Ana; MONTENEGRO, Mary; GURIAN, Maria; et al. Perineal Massage Improves the Dyspareunia Caused by Tenderness of the Pelvic Floor Muscles. Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, v. 39, n. 01, p. 26–30, 2016. Disponível em: <https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032017000100026>. Acesso em: 14 de Abril. 2020.
SILVA, Ana Paula Moreira da. Abordagem fisioterapêutica da dispareunia na mulher com dor pélvica crônica: comparação entre duas técnicas. Trial clínico, randomizado. 2020. Disponível em: <https://teses.usp.br/teses/disponiveis/17/17145/tde-19072018-115253/pt-br.php>. Acesso em: 07 de Abril. 2020.
STRAUB, Rainer H. The Complex Role of Estrogens in Inflammation. Endocrine Reviews, v. 28, n. 5, p. 521–574, 2007. Disponível em: <https://pubmed.ncbi.nlm.nih.gov/17640948/>. Acesso em: 04 de Junho. 2020.
TRONCON, Júlia Kefalás; PANDOCHI, Heliana Aparecida da Silva; LARA, Lúcia Alves. Abordagem da dor gênito-pélvica/penetração. Revista Brasileira de Sexualidade Humana, v. 28, n. 2, p. 69–74, 2018. Disponível em: <https://sbrash.emnuvens.com.br/revista_sbrash/article/view/25>. Acesso em: 15 de Junho. 2020.
VIEIRA, Kay Francis Leal; NÓBREGA, Renata Pires Mendes da; ARRUDA, Maria Valdênia Soares; et al. Representação Social das Relações Sexuais: um Estudo Transgeracional entre Mulheres. Psicologia: Ciência e Profissão, v. 36, n. 2, p. 329–340, 2016. Disponível em: <https://www.scielo.br/scielo.php?pid=S1414-98932016000200329&script=sci_abstract&tlng=pt>. Acesso em: 17 de Maio. 2020.