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
INTERSTITIAL CYSTITIS
Controlled, randomized, and multi-site clinical trial of physical therapy for the treatment of interstitial cystitis in both women and men.
Controlled, randomized, and multi-site clinical trial of physical therapy for the treatment of interstitial cystitis in women.
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.
Research describing a validated questionnaire for evaluating interstitial cystitis symptoms.
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.
A population-based study of anxiety and depressive symptoms in women with interstitial cystitis.
Early clinical trial evaluating the efficacy of pelvic floor physical therapy for the treatment of interstitial cystitis.
An article explaining the history of the nomenclature used to describe interstitial cystitis and how the condition has been defined.
Early clinical trial evaluating the efficacy of physical therapy as a treatment for interstitial cystitis.
Effect of food triggers on symptoms of interstitial cystitis.
Clinical trial of oral amitriptyline for treating IC symptoms.
Controlled, randomized trial of pentosan polysulfate (Elmiron) to treat interstitial cystitis symptoms.
Clinical trial of Lidocaine installation for treatment of interstitial cystitis symptoms.
Pentosan polysulfate (PPS, Elmiron(R)) was not shown to be significantly more effective than a placebo in a controlled, randomized clinical trial.
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.
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.
This study demonstrates that the severity of endometriosis does not correlate with the symptoms experienced by patients.
The prevalence of endometriosis is approximately one in ten women, but it takes an average of 8-10 years to receive a diagnosis.
Survey of general practitioners and specialists about their comfort level in diagnosing and treating endometriosis.
Myofascial pain and dysfunction, along with nervous system upregulation, plays an important role in the symptoms of endometriosis.
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.
Examining the recurrence rate of endometriosis after hysterectomy.
A systematic review of hormone therapy and medical management of endometriosis.
Understanding the effects of a gluten-free diet on endometriosis symptoms.
Efficacy of hormone therapy for the treatment of endometriosis.
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).
Clinical trial assessing the efficacy of yoga in the treatment of endometriosis symptoms.
Evaluating the combination of stress reduction and physical therapy in the management of endometriosis symptoms.
Assessment of the efficacy of acupuncture in treating the symptoms of endometriosis.
Both physical therapy and hysterectomy significantly reduce reports of chronic pain in patients with endometriosis.
Pregnancy &
Post-Natal
Pelvic floor training during pregnancy significantly reduces the risk of post-natal incontinence.
Pelvic floor training during pregnancy significantly reduced post-natal incontinence by more than 40% in mothers.
Pelvic floor exercises during pregnancy reduce the risk of incontinence both during the third trimester and after birth.
Length of the second stage of labor was reduced by pelvic floor muscle training during pregnancy.
Women who did not receive pelvic floor muscle training during pregnancy were nearly twice as likely to have post-natal incontinence.
Prevalence of different kinds of major pelvic floor dysfunction in women (46.7%) and men (11.1%) in a cross-sectional study.
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.
Determining the prevalence and risk factors for diastasis recti following childbirth.
Determining the prevalence of diastasis recti following childbirth.
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.
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.
Evaluating the ability of mindfulness meditation to reduce pain.
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.
Review article concluding that mindfulness practice is beneficial in treating anxiety and depression, even without the benefit of a larger therapeutic framework.
A research review concluding that mindfulness practice has the ability to promote weight loss and reduce obesity-related eating behaviors.
In a review of more than twenty studies, researchers concluded that eight different brain regions were consistently altered in those who practiced meditation.
Research demonstrates that mindfulness practice is effective in improving anxiety and mood symptoms.
Mindfulness has been shown to decrease binge eating and emotional eating.
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.
A review article concluding that mindfulness is a promising treatment for substance abuse.
Research has demonstrated that mindfulness practice may be able to decrease implicit race and age bias.
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.
Almost 90% of studies reported improvement of negative eating behaviors with mindfulness interventions.
Cognitive-behavioral therapy (CBT) compared with traditional psychotherapy in the reduction of pelvic pain.
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.
Mindfulness has shown benefits in reducing symptoms of functional gastrointestinal disorders in a review of seven studies
Painful Intercourse
A 2015 paper summarizing new standards for vulvar pain terminology.
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.
Urinary Symptoms
Pelvic floor muscle training and bladder training shown to be just as effective as oral medication in treatment of urinary incontinence.
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.
Adding targeted Pilates classes to physical therapy improved quality of life and outcomes for women with urinary 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.
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.
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.
PelvicSanity Staff Articles
Pelvic floor physical therapy is the most proven treatment for interstitial cystitis. It’s the only therapy given an evidence grade of ‘A’ by the American Urological Association and recommended in the first line of medical treatment. But patients often wonder how does treating muscles and fascia reduce urinary symptoms and pain that seem to be coming from the bladder?
A report on a retrospective clinical trial for pelvic floor physical therapy for interstitial cystitis. Of the thirteen patients, all reported significant improvements. Pain and symptom bother were both reduced by more than 65%, with more than half of patients noticing an improvement within their first three visits.
A detailed case report on the physical therapy treatment of a women with interstitial cystitis, dyspareunia, and low back pain. After 19 visits over 3 months, the patient was able to resume full-time employment and sexual intercourse. Pain was reduced by nearly 80% over the course of treatment.
Written for the ICA Update, this patient-focused article examines how recognizing your mindset - and realizing there are ways to shift it - are keys in the road to recovery from IC and pelvic floor dysfunction. It guides patients on becoming both better-informed on their condition and more realistically optimistic about their prognosis - creating the conditions for informed optimism, or hope.
It's clear that successfully treating interstitial cystitis requires looking beyond the bladder. The vast majority of patients with IC also have pelvic floor dysfunction, which can be causing or exacerbating both pain and urinary symptoms. Research continues to highlight that recognizing and resolving pelvic floor dysfunction is among the most important aspects of IC treatment.
For patients with pelvic pain or pelvic floor dysfunction, how you interact with your doctor can have a major impact on how you are diagnosed and treated.
A self-care stretching regimen for patients with pelvic floor dysfunction can alleviate symptoms, maintain the gains of physical therapy, and provide long-term preventative maintenance.
A patient-centered overview of the pelvic floor and how pelvic floor physical therapy can alleviate pelvic pain and urinary symptoms in interstitial cystitis and other conditions.
Men with interstitial cystitis also benefit from pelvic floor physical therapy. Pelvic floor physical therapy can address the pelvic floor component of IC symptoms, present in more than 80% of both men and women with an IC diagnosis.
Physical therapy is the most proven treatment for interstitial cystitis. In studies conducted at PelvicSanity, we evaluated our patients with IC and found that they saw more than a 60% improvement in both the pain and bother of their symptoms. More than half saw benefits within the first three visits.
In April of 2018, Nicole will be teaching the first continuing education course for physical therapists focused on interstitial cystitis.
"Most importantly, quercetin is one of the few supplements that have been proven effective in clinical trials for pelvic pain. In a randomized study of men with chronic prostatitis, quercetin was shown to benefit more than 2 in 3 men. Symptoms were improved by an average of 38 percent, without significant side effects being reported by the researchers."
Quercetin is part of our Pelvic Health Supplement pack, along with L-Arginine and Omega-3 Fish Oil.
"By resolving the trigger points in these muscles, pelvic floor physical therapy works to address the underlying cause of pelvic pain and urinary symptoms. This typically involves both external and internal trigger point release techniques, clearing inflammation from the fascia, and a customized at-home program.
"The results were striking. In just ten visits, 64% of men reported their symptoms were either moderately or markedly improve, and more than 80% reported at least some benefit...."
The goal is to improve the current trial-and-error approach to treatment. If we can identify underlying phenotypes, it may be possible to predict which treatments will be most effective for a specific patient. This fits with a more individualized approach to medicine, as we realize that there’s no one-size-fits-all approach for complex conditions.
"Many patients with chronic prostatitis and pelvic pain report that their symptoms get worse during the cold weather months. It’s not just in your head – recent research confirmed the relationship between weather and pain....In fact, pain intensity was reported to be three times greater during the winter months, and the correlation was present for every man in the study.
These results correspond with the muscles of the pelvic floor being a driving force behind pelvic pain with chronic prostatitis. As the temperature drops, these muscles get even tighter, irritating the nerves that run through the pelvis...."
"The number of trigger points was significantly associated with anxiety, stress, pain experience, and both physical and mental quality of life in patients....Multiple treatments are effective in reducing or eliminating trigger and tender points for pelvic pain. Pelvic floor physical therapy for chronic prostatitis resolves trigger points with manual therapy..."
"“We treat many men for pelvic pain and/or urinary symptoms, often diagnosed as chronic prostatitis, ‘cyclist syndrome,’ or levator ani syndrome. It’s common for these men to also be suffering from sexual pain or dysfunction that they may not even realize is related, until it also starts to improve with pelvic floor physical therapy.” — Dr. Nicole Cozean, PT, DPT, WCS, CSCS