Endometriotic pelvic pain and dyspareunia: a comparison of physical therapy vs. surgical intervention

Background and Purpose: Endometriosis is a common gynecological condition occurring when endometrial tissue is found outside the uterine cavity, known as endometriotic lesions. Pelvic pain, associated with endometriosis, is the primary complaint among patients. Though surgery is a common intervention for endometriosis, risks include surgical complications and the possibility of recurring endometriotic lesions. Based on the interventions within a physical therapist’s scope of practice to address pain and dysfunction, physical therapy may be a more conservative treatment option in addressing the symptoms associated with endometriosis, including pelvic pain. Therefore a review of current literature was performed to determine whether physical therapy intervention was comparable to surgery in effectively reducing symptoms of endometriosis. Case Description: The patient is a 33-year old Caucasian female, Gravida 0, referred to physical therapy for constant pelvic pain and dyspareunia, secondary to suspected endometriosis. Symptom onset May 2014. Outcomes: Physical therapy aided in the decrease of patient’s pelvic pain and dyspareunia, as the patient reported improvement in function and quality of life. All PT goals set for the patient at initial evaluation were met within 8 weeks. Discussion: Quality research assessing the efficacy of physical therapy and surgery as interventions for endometriosis is very limited, however recent studies do exist. Based on current evidence, it appears physical therapy is comparable to surgery in significantly reducing pelvic pain related to endometriosis, however long-term effects of both interventions remain unknown.Beth M. Jones, PT, DPT, MS, OCS Deborah Doerfler, PT, DPT, PhD, OC