Kalina, C.; Novacare, Fairfax, VA. kalinajc@erols.com.

PURPOSE: Dyspareunia is a common complaint among women presenting to physicians in primary care settings. This case study describes the physical therapy evaluation and treatment of a woman with dyspareunia of musculo-skeletal origin. SUBJECT: This is a single-subject case report of a 29 year old female patient with a nine year history of dyspareunia. METHODS AND MATERIALS: The patient’s chief complaint was of introital dyspareunia with a secondary complaint of deeper penetration dyspareunia. There was a marked decrease in the frequency of intercourse secondary to the pain. Objectively, the patient presented with marked restrictions of her epsiotomy scar and perineal body in addition to increased tension of the bilateral bulbospongiosis, levator ani, obturator internus, coccygeus and hip adductor muscles. Manual stretching applied to the episiotomy scar and perineal body reproduced the patient’s introital dyspareunia. Deeper penetration dyspareunia was reproduced with palpation of the levator ani muscle. The patient was treated for seven visits. Treatment included external and intravaginal soft tissue mobilization and myofascial release. The patient was instructed in a daily home program which included self-scar mobilization, stretching exercises, relax training and use of a vaginal dilator to provide a more functional stretch to the restricted tissues. ANALYSES: Subjective information from the patient and objective data gathered from the physical therapy assessments are compared before and after the physical therapy treatment is applied. RESULTS: Following seven physical therapy visits, the patient’s dyspareunia was fully resolved. The patient resumed intercourse at her desired frequency. CONCLUSIONS: Manual physical therapy treatment can effectively resolve dyspareunia of musculo-skeletal origin. FUNDING SOURCE: None.

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