Pelvic Health Research Portal

Welcome to the Pelvic Health Research Portal, where we have compiled the most important studies in the field of pelvic health as a resource for both practitioners and patients. 

NAVIGATION

Articles in this directory are organized by diagnosis, and you can use the navigation menu to jump directly to the diagnosis you're looking for.  Each article has a brief description along with the full citation.  Click on the full reference at the bottom-right to be linked directly to the article.  

FOUNDERS

The Pelvic Health Research Portal is founded by Dr. Nicole Cozean, and maintained by the PelvicSanity team.  We have also written individual blog posts on many of these article, which can be found at the PelvicSanity blog.  The team also runs a Facebook group for practitioners to share experience, research and knowledge at the Pelvic PT Huddle, and a free online support group for patients Finding PelvicSanity.

GROWING RESOURCE

This resource is alive and growing; if you have an article you think should be included, please contact us with the name of the article and a link to where it can be found online.  

Links to the books here are affiliate links - it doesn't change the price that you pay, but if you do purchase a book from Amazon after clicking the link, we do get a few cents in commission that we use to maintain this free resource.

 

BOOKS

A highly detailed explanation of how pelvic pain occurs and how to treat it; an excellent resource for patients and practitioners alike.

2017

Named 'the best book on IC in the last 20 years', The IC Solution is a complete guide to interstitial cystitis.  Written for both patients and their practitioners, it lays out the treatment options and helps patients create their own unique treatment plan.

2016

A self-treatment guide to alleviating painful intercourse, Sex without Pain is written by a pelvic floor physical therapist and focuses on both a dilator program for internal work and stretching program for the large muscles that connect with the pelvis.

2014

Written by a physical therapist who suffered from chronic pelvic pain, Healing Through Chronic Pain is a patient's account of her journey through physical therapy, medical management, and holistic healing to find relief.

2013

Written by a pelvic floor physical therapist, Ending Male Pelvic Pain focuses on how men can address pelvic floor issues causing pelvic pain.

2013

A description of the medical causes of painful intercourse from three leaders in the field.  A great resource for women struggling with painful sex to understand the medical and surgical interventions available.

2011

Written by a pelvic floor physical therapist, Ending Female Pelvic Pain focuses on how women can address pelvic floor issues causing pelvic pain.

2009

An explanation and treatment plan for men with chronic prostatitis written by leading researchers from Stanford University.

2003

A concise and clearly written book, Heal Pelvic Pain gives a straightforward explanation of pelvic pain and a stretching and exercise regimen to improve pelvic health.

2008

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INTERSTITIAL CYSTITIS

Important study from the RAND Corporation that showed the prevalence of interstitial cystitis was far higher than had previously been assumed, up to 12 million individuals in the United States alone.

The American Urological Association released guidelines for treatment in 2011, and later updated them in 2014.  They recommend patients proceed through six 'lines' of treatment based on the evidence of efficacy for each treatment.

From the large RAND survey, this study evaluates the prevalence of depressive symptoms and suicidal ideation among patients with interstitial cystitis. 

From the RAND survey, this study looks at the prevalence of interstitial cystitis in men and how the diagnosis is often confused with chronic prostatitis, concluding that the prevalence of IC in men is far higher than had initially been suspected.

The authors examined the link between urine acidity and interstitial cystitis symptoms, finding that the acidity of urine did not increase symptoms.

Illness perception plays an important role in dealing with chronic pelvic pain, and negative perception is associated with poor pain modulation and less successful outcomes with manual physical therapy.

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Endometriosis

 

Study reporting on the most common symptoms of endometriosis, including GI symptoms, bloating, irritable bowel syndrome (IBS) and more.

Research on how many women with chronic pelvic pain are diagnosed with endometriosis upon laparoscopy.

Study examining the need for follow-up surgeries after endometriosis excision, showing 21-37% of women request an additional surgery within two years of the initial procedure.

Endometriosis pain and symptoms are related to myofascial trigger points in the abdomen (found in 94% of women) and the pelvic floor (61% of women).

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Pregnancy &

Post-Natal

Prevalence of post-natal pelvic floor dysfunction, with no difference in symptoms seen between C-section and vaginal delivery

The authors examine the gait of pregnant women with and without pelvic pain, finding that pelvic pain was associated with increased pelvic rotation and pelvic asymmetry. 

Women with sexual dysfunction prior to pregnancy continued to experience it through pregnancy and into the postpartum period, but there was no correlation between sexual dysfunction occurring in pregnancy and post--natal symptoms.

At 10 months postpartum, 28% of women with C-section deliveries and 46% of women with vaginal deliveries reported dyspareunia, and both caesarean and perineal scars were associated with sexual dysfunction.

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Mind-Body Connection

In a review of 23 studies, mindfulness practice was found to reduce emotional exhaustion, stress, psychological distress, depression, anxiety, and occupational stress.  Further improvements were noted in personal accomplishment, self-compassion, quality of sleep, and relaxation.

Long-term mindfulness practice has been shown to improve cognitive function, but this study demonstrates that 4 days of meditation training was able to reduce fatigue, anxiety, and improve working memory and the ability to sustain attention.

Review article examining the evidence of mindfulness to improve the immune system, showing some evidence of changes in specific inflammation markers and immunity.

A research review concluding that mindfulness practice has the ability to promote weight loss and reduce obesity-related eating behaviors.

In reviewing 209 studies, researchers found mindfulness to be effective in treating a variety of psychological problems, especially anxiety, depression, and stress.

In a seminal study, researchers demonstrated that people are less happy when their minds are wandering, which occurs nearly half of the time for most people.

Mindfulness interventions were shown to decrease the intensity of pain for chronic pain patients over 16 different studies.

Mindfulness is shown in this study to reduce the physical markers of stress within the body, including blood pressure, heart rate, cortisol levels, and inflammation markers.

Patients with chronic pelvic pain saw an increase in gray matter density in areas of the brain associated with pain processing, mood, and motor-sensory function.

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Painful Intercourse

Using imaging techniques, the authors demonstrated that women with provoked vestibulodynia have increased pelvic floor muscle tone and decreased muscle strength.

Women with vulvar vestibulitis syndrome demonstrated significantly more vaginal hypertonicity, lack of muscle strength, and restriction of the vaginal opening.  Pelvic floor physical therapists were consistently able to diagnose pelvic floor dysfunction in this patient population.

An early study in the prevalence of dyspareunia, finding that 61% of women reported experiencing painful intercourse at some point in their lives, with 16% of women experiencing it for their entire adult life.

Review article on the evaluation, causes, and treatment for dyspareunia.

The Female Sexual Function Index (FSFI) is validated, self-reporting questionnaire on sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain.

Dyspareunia and sexual dysfunction are common during the third trimester of pregnancy and postpartum, with more than half of women reporting postpartum painful intercourse.

Dyspareunia and sexual dysfunction are common during the third trimester of pregnancy and postpartum, with more than half of women reporting postpartum painful intercourse.

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Urinary Symptoms

 

Physical therapy was shown to be an effective treatment for overactive bladder, with 85% of patients who received myofascial release reporting symptom improvement.  This was significantly higher than patients who received only strength training (26% reported improvement).

A systematic review of pelvic floor muscle training for the treatment of stress urinary incontinence.  Women who received PFMT were 17 times more likely to report an improvement or cure of their symptoms as compared to untreated controls.

Pelvic floor muscle training effective reduced overactive bladder symptoms in men and women, including urgency, frequency, and nocturia.  

Literary review of outcomes for pelvic floor disorders treated with pelvic floor muscular training, biofeedback, behavioral training, e-stim, acupunture and cognitive behavioral interventions.

Group classes teaching participants to perform Kegels during activities that increase intra-abdominal pressure showed no statistically significant difference when compared to a control group in women with incontinence.

Patients who presented with pelvic floor symptoms of dysuria, urinary urgency/frequency, and pelvic pain also had a higher risk of myofascial pain syndrome.  Only 31% of patients presenting with these symptoms were diagnosed with a urinary tract infection.

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Pelvic Floor Physical Therapy

 

The authors report on a controlled clinical trial for intravaginal e-stimulation, which was not more effective than the sham procedure in pain, quality of life, sexual function, or pelvic floor symptoms.

Physical therapy was found to be more efficacious than lidocaine for reducing pain during intercourse, sexual distress, and sexual dysfunction.  In total, 77% of women in the physical therapy group reporting significant improvement in their symptoms as compared to 38% in the lidocaine group.  

Sixty percent of patients with chronic pelvic pain reported a perceived benefit of BOTOX injections to the pelvic floor, while 74% reported a benefit with the combination of BOTOX and pelvic floor physical therapy

The combination of pelvic floor physical therapy and diazepam suppositories resulted in subjective improvement in 96% (25 of 26) women with high-tone pelvic floor and sexual pain.

A retrospective evaluation of the prevalence of myofascial pelvic pain and the effectiveness of pelvic floor physical therapy in addressing symptoms.  Pain scores significantly improved, proportionally to the number of physical therapy visits, and 63% of patients reported significant pain improvement.

Myofascial trigger point release and paradoxical relaxation techniques significantly improved symptoms in 72% of men with chronic pelvic pain.

Pelvic floor physical therapy was considered successful for 77% of women with provoked vestibulodynia, with improvements in sexual function.

Women with urinary incontinence had a thinner pelvic floor than women without incontinence.  Gains in the size/strength of the pelvic floor muscles from Kegel exercises were not correlated with symptom improvement.

Background information on the short pelvic floor in patients, discussing the syndromes associated with a shortened pelvic floor and effective therapeutic techniques.

When treated for their chronic pelvic pain, women also experienced a reduction of pain sensitivity in other areas of the body, suggesting nervous system upregulation plays a major role in chronic pelvic pain.

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PelvicSanity Staff Articles