A randomized controlled trial depicted that pelvic floor physiotherapy effectively improves chronic pelvic pain in females with deep infiltrating endometriosis. It also improves pelvic floor muscle relaxation and superficial dyspareunia, thus leading to a rise in the levator hiatal area. This study was performed to explore the impact of pelvic floor physiotherapy on females having superficial dyspareunia and deep infiltrating endometriosis.

The study cohort included 34 nulliparous females diagnosed with deep infiltrating endometriosis and related superficial dyspareunia. Participants were randomly allocated to (i) Intervention group (treatment with five individual sessions of pelvic floor physiotherapy, n=17) or (ii) Control group (no intervention, n=17). Four months following the initial assessment, all females underwent a second assessment of pain symptoms (utilizing the Numerical Rating Scale [NRS]) and transperineal ultrasound.

During the ultrasound assessments, the levator hiatal area under Valsalva maneuver was estimated with 3D/4D transperineal ultrasound at rest, upon maximum Valsalva maneuver, and maximum pelvic floor muscle contraction. Alteration in the levator hiatal area at maximum Valsalva maneuver between the two assessments in the two arms was the major endpoint.

Notably, 30 females completed the study and were incorporated into the analysis (intervention group n=17, control group, n=13). The percentage alteration in levator hiatal area at maximum Valsalva maneuver between the two assessments was elevated in the intervention cohort compared to the subjects given no intervention.

Following therapy, the alteration in the NRS score of superficial dyspareunia was elevated in the intervention group compared to the control group. Furthermore, at the second assessment, vital differences between the arms were witnessed regarding chronic pelvic pain.

Thus, pelvic floor physiotherapy alleviates chronic pelvic pain in females having deep infiltrating endometriosis.