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Case Report of a Postpartum Patient With Vestibulodynia, Dyspareunia, Constipation, and Stress Urinary Incontinence

Olszewski, Rose Marie DPT

Journal of Women’s Health Physical Therapy: January/April 2012 - Volume 36 - Issue 1 - p 20–34
doi: 10.1097/JWH.0b013e31824e0b12
Case Reports

Background: Dyspareunia and vestibulodynia have multifactorial influences. The effects of postpartum changes on these disorders as well as secondary complications of constipation and stress urinary incontinence (SUI) are explored in the following case report.

Study Design: This is a single-case report with detailed information on patient examination, evaluation, intervention, and outcomes.

Case Description: This case involved a postpartum woman with onset of dyspareunia, vestibulodynia, SUI, and constipation. Intervention included bladder normalization, manual therapy applied to pelvic floor muscles (PFMs), PFM strengthening and coordination exercises, abdominal strengthening, dilator use, and extensive education including the role of the PFM and bowel, bladder, and sexual function.

Outcomes: This patient had attended 9 physical therapy sessions over a 3-month period. With physical therapy treatment, she was able to use tampons and have intercourse without discomfort. In addition, episodes of SUI and constipation were eliminated.

Discussion: Little research places emphasis on the physiologic and psychologic changes that can affect a postpartum woman and her return to intercourse. This case report explores such changes in a patient with dyspareunia and vestibulodynia. Intervention addressed multiple issues including chronic pain sensitization, habitual muscle guarding, weak abdominal muscles, and PFM dysfunction. Treatment was found to be successful in eliminating this patient's dyspareunia, constipation, and SUI. Further research regarding postpartum changes and pelvic floor dysfunction is needed so that medical providers can prevent women from developing postpartum dyspareunia. By doing so, proper examination, evaluation, and treatment can be enacted sooner, and chronic pain and dysfunction may be avoided.

Brigham and Women's Hospital, Boston, Massachusetts.

The author declares no conflicts of interest.

Copyright © 2012 Section on Women's Health, American Physical Therapy Association