Background: The neuromuscular contribution to increased tone of the pelvic floor muscles (PFMs) observed among those with provoked vestibulodynia (PVD) is unclear. Aim: To determine if PFM activity differs between those with provoked PVD and pain free controls, and if the extent of PFM activation at rest or during activities is associated with pain sensitivity at the vulvar vestibule, psychological, and/or psychosexual outcomes. Methods: This observational case-control study included forty-two volunteers with PVD and 43 controls with no history of vulvar pain. Participants completed a series of questionnaires to evaluate pain, pain catastrophizing, depression, anxiety and stress, and sexual function, then underwent a single laboratory-based assessment to determine their pressure pain threshold at the vulvar vestibule and electromyographic (EMG) signal amplitudes recorded from three PFMs (pubovisceralis, bulbocavernosus, and external anal sphincter). Outcomes: EMG signal amplitude recorded at rest, during maximum voluntary contraction (MVC), and during maximal effort Valsalva maneuver, pressure pain threshold at the vulvar vestibule, and patient-reported psychological (stress, anxiety, pain catastrophizing, central sensitization) and psychosexual (sexual function) outcomes. Results: Participants with PVD had higher activation compared to controls in all PFMs studied when at rest and during Valsalva maneuver. There were no group differences in EMG amplitude recorded from the pubovisceralis during MVC (Cohen's d = 0.11), but greater activation was recorded from the bulbocavernosus (d = 0.67) and the external anal sphincter(d = 0.54) among those with PVD. When EMG amplitudes at rest and on Valsalva were normalized to activation during MVC, group differences were no longer evident, except at the pubovisceralis, where tonic EMG amplitude was higher among those with PVD (d = 0.42). While those with PVD had lower vulvar pressure pain thresholds than controls, there were no associations between PFM EMG amplitude and vulvar pain sensitivity nor psychological or psychosexual problems. Clinical implications: Women with PVD demonstrate evidence of PFM overactivity, yet the extent of EMG activation is not associated with vulvar pressure pain sensitivity nor psychological/psychosexual outcomes. Interventions aimed at reducing excitatory neural drive to these muscles may be important for successful intervention. Strengths and limitations: This study includes a robust analysis of PFM EMG. The analysis of multiple outcomes may have increased the risk statistical error, however the results of hypothesis testing were consistent across the three PFMs studied. The findings are generalizable to those with PVD without vaginismus, Conclusions: Those with PVD demonstrate higher PFM activity in the bulbocavernosus, pubovisceralis, and external anal sphincter muscles at rest, during voluntary contraction (bulbocavernosus and external anal sphincter) and during Valsalva maneuver; yet greater activation amplitude during these tasks is not associated with greater vulvar pressure pain sensitivity nor psychological or psychosexual function.

Background The nature of pelvic floor muscle (PFM) involvement in provoked vestibulodynia (PVD) is poorly understood. Aim We aimed to determine if PFM electromyographic (EMG) activity in anticipation of or response to pressure applied to the posterior vaginal fourchette differs between those with and without PVD, and if the magnitude of PFM response is associated with pressure pain sensitivity, psychological or psychosexual function. Methods This was an observational case–control study. Forty-two volunteers with PVD and 43 controls with no vulvar pain participated. Five on-line questionnaires were completed, then participants underwent a laboratory-based evaluation of vulvar pain sensitivity. EMG activation of the PFMs, hip adductor, and upper trapezius muscles was measured before, during, and after pressure stimuli (low, moderate) were applied, in random order, to the posterior vaginal fourchette and the posterior thigh (control site). Outcomes EMG amplitude of the pubovisceralis (PV), bulbocavernosus (BC), and external anal sphincter (EAS) muscles. Secondary outcomes were EMG activation of the hip adductor brevis and upper trapezius muscles, questionnaire scores reflecting psychological/psychosexual outcomes, pressure pain threshold (PPT) at the vulvar vestibule, pain reported on a tampon test, and heart rate/heart rate variability. Results Compared to controls, EMG activation of the PV and EAS, but not the BC, was higher in anticipation of the pressure applied to the vaginal fourchette, was higher in all PFMs while the pressure was applied, and remained higher than baseline after the pressure was removed among those with PVD. EMG response amplitudes were modulated by the intensity of the pressure applied, with the largest responses reaching over 40% MVC in the EAS among those with PVD. PFM EMG amplitudes were associated with greater pain sensitivity and lower sexual function, but not with pain catastrophizing, central sensitization, depression, anxiety, or stress. Clinical implications While some anticipatory activation was observed, EMG responses were primarily observed during and after the application of the pressure. Among those with PVD, digital assessment of PFM tone might reflect PFM responses to pain at the vulvar vestibule, and interventions to reduce local pain sensitivity may be an important first step to successful improvements in vaginal function. Strengths and limitations This study includes a robust analysis of EMG activation. However, the cross-sectional design precludes the determination of causal relationships. Conclusions Those with PVD demonstrate higher PFM responses and a higher prevalence of anticipatory activation in the PV and EAS muscles than controls in response to pressure applied at the vulvar vestibule

Small animal models have been developed to study aging and ovarian failure to gain an understanding of how muscle composition, structure and function is altered in menopause. This systematic review aimed to determine 1) how aging and ovarian failure have been modeled in small animals to examine changes in the levator ani muscles (LAMs) and the external anal sphincter (EAS) and 2) how aging and ovarian failure in small animals impact the composition, structure and function of the LAMs and EAS.

Through developing new measures, authors have recently shown associations between aging and changes in levator hiatus (LH) shape. Our aim was to assess the test-retest reliability of LH shape at rest and during maximum voluntary contractions (MVCs) in women. To date, six women have been recruited to attend two assessments. Four measures of LH shape were assessed using ultrasound imaging at rest and on MVC. Spearman’s rho were used to determine the strength of between-day associations. Most measures demonstrated moderate to strong associations, however, many lack statistical significance. Recruitment is ongoing and we anticipate finding stronger associations with a larger sample size. Reliable quantification of morphology will provide insight into how age-related changes in LH shape may be relevant to pelvic floor symptoms.

Active women have reported that running and jogging aggravate urine leakage. Our aim was to develop a theoretical model to describe the relationships among the pathophysiology, symptoms, mitigating factors, management and impact of brisk walking and running induced lower urinary tract symptoms (BRUTS) among active women. A focus group, including researchers, patients and clinicians, participated in four sessions, culminating in a theoretical model for BRUTS. The model describes the influence of modifiers on pelvic organ support during exercise. Sufficient loss of support drives symptoms, with symptom bother leading to response strategies. Satisfaction with strategies will determine continuation, reduction or withdrawal from exercise. The BRUTS model is the starting point for developing a patient reported outcome measure for use in research to examine the efficacy of interventions.