Diagnosis and Management of Myofascial Pelvic Pain Syndrome: A Review

Chronic Pelvic Pain. ACOG practice Bulletin, number 218. Obstet Gynecol. 2020;135(3):e98. https://doi.org/10.1097/AOG.0000000000003716

Article  Google Scholar 

Namazi G, Chauhan N, Handler S. Myofascial pelvic pain: the forgotten player in chronic pelvic pain. Curr Opin Obstet Gynecol. 2024;36(4):273–81. https://doi.org/10.1097/GCO.0000000000000966.

Article  PubMed  Google Scholar 

Janet G, Travell DS. Myofascial Pain And Dysfunction: The Trigger Point Manual. 3rd Edition.; 2019. Accessed July 7, 2025. http://archive.org/details/myofascial-pain-and-dysfunction-the-trigger-point-manual-by-janet-g.-travell-dav

Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiol Clin. 2007;25(4):841–51. https://doi.org/10.1016/j.anclin.2007.07.003.

Article  PubMed  Google Scholar 

Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2011;25(2):185–98. https://doi.org/10.1016/j.berh.2011.01.002.

Article  PubMed  Google Scholar 

Yap EC. Myofascial pain–an overview. Ann Acad Med Singapore. 2007;36(1):43–8.

Article  PubMed  Google Scholar 

Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. 2008;12(4):371–84. https://doi.org/10.1016/j.jbmt.2008.06.006.

Article  PubMed  Google Scholar 

Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004;8(6):468–75. https://doi.org/10.1007/s11916-004-0069-x.

Article  PubMed  Google Scholar 

Volcheck MM, Graham SM, Fleming KC, Mohabbat AB, Luedtke CA. Central sensitization, chronic pain, and other symptoms: better understanding, better management. Cleve Clin J Med. 2023;90(4):245–54. https://doi.org/10.3949/ccjm.90a.22019.

Article  PubMed  Google Scholar 

Meister MR, Sutcliffe S, Ghetti C, et al. Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain. Am J Obstet Gynecol. 2019;220(3):255. .e1-255.e9.

Article  Google Scholar 

Harm-Ernandes I, Boyle V, Hartmann D, et al. Assessment of the pelvic floor and associated musculoskeletal system: guide for medical practitioners. Female Pelvic Med Reconstr Surg. 2021;27(12):711–8. https://doi.org/10.1097/SPV.0000000000001121.

Article  PubMed  Google Scholar 

Meister MR, Sutcliffe S, Badu A, Ghetti C, Lowder JL. Pelvic floor myofascial pain severity and pelvic floor disorder symptom bother: is there a correlation? Am J Obstet Gynecol. 2019;221(3):235. .e1-235.e15.

Article  PubMed Central  Google Scholar 

Peters KM, Carrico DJ. Frequency, urgency, and pelvic pain: treating the pelvic floor versus the epithelium. Curr Urol Rep. 2006;7(6):450–5. https://doi.org/10.1007/s11934-006-0053-6.

Article  PubMed  Google Scholar 

Tu FF, As-Sanie S, Steege JF. Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic. J Reprod Med. 2006;51(3):185–9.

PubMed  Google Scholar 

Moldwin RM, Fariello JY. Myofascial trigger points of the pelvic floor: associations with urological pain syndromes and treatment strategies including injection therapy. Curr Urol Rep. 2013;14(5):409–17. https://doi.org/10.1007/s11934-013-0360-7.

Article  PubMed  Google Scholar 

Zhang J, Pang T, Yao J, et al. Clinical application of myofascial therapy in the treatment of postpartum pain-related functional disorders: a review. Medicine. 2024;103(40):e39869. https://doi.org/10.1097/MD.0000000000039869.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Tenfelde S, Tell D, Brincat C, Fitzgerald CM. Musculoskeletal pelvic pain and sexual function in the first year after childbirth. J Obstetric Gynecologic Neonatal Nurs. 2019;48(1):59–68. https://doi.org/10.1016/j.jogn.2018.10.004.

Article  Google Scholar 

Solano Calvo JA, Barreiro García JM, González Hinojosa J, Delgado Espeja JJ, Rodríguez Miguel A, Zapico Goñi Á. Treatment of postpartum myofascial perineal pain and dyspareunia through local anaesthetic infiltrations compared to anaesthetic and corticosteroids: a randomised double-blind clinical trial. J Clin Med. 2025;14(9):3228. https://doi.org/10.3390/jcm14093228.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Snooks SJ, Swash M, Henry MM, Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorectal Dis. 1986;1(1):20–4. https://doi.org/10.1007/BF01648831.

Article  CAS  PubMed  Google Scholar 

Meister MR, Shivakumar N, Sutcliffe S, Spitznagle T, Lowder JL. Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review. Am J Obstet Gynecol. 2018;219(5):497. .e1-497.e13.

Article  Google Scholar 

Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019;31(6):485–93. https://doi.org/10.1097/GCO.0000000000000584.

Article  PubMed  Google Scholar 

FitzGerald MP, Payne CK, Lukacz ES, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012;187(6):2113–8. https://doi.org/10.1016/j.juro.2012.01.123.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Bedaiwy MA, Patterson B, Mahajan S. Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy. J Reprod Med. 2013;58(11–12):504–10.

PubMed  Google Scholar 

Killinger KA, Henrichsen JL, Han E, et al. Symptom and quality of life improvements after pelvic floor physical therapy in a clinical population of women with pelvic pain and other symptoms. Female Pelvic Med Reconstr Surg. 2021;27(1):e18–21. https://doi.org/10.1097/SPV.0000000000000783.

Article  PubMed  Google Scholar 

van Reijn-Baggen DA, Han-Geurts IJM, Voorham-van der Zalm PJ, Pelger RCM, Hagenaars-van Miert CHAC, Laan ETM. Pelvic floor physical therapy for pelvic floor hypertonicity: A systematic review of treatment efficacy. Sex Med Rev. 2022;10(2):209–30. https://doi.org/10.1016/j.sxmr.2021.03.002.

Article  PubMed  Google Scholar 

Tu FF, As-Sanie S, Steege JF. Musculoskeletal causes of chronic pelvic pain: a systematic review of existing therapies: part II. Obstet Gynecol Surv. 2005;60(7):474–83. https://doi.org/10.1097/01.ogx.0000162246.06900.9f.

Article  PubMed  Google Scholar 

Oyama IA, Rejba A, Lukban JC, et al. Modified thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology. 2004;64(5):862–5. https://doi.org/10.1016/j.urology.2004.06.065.

Article  PubMed  Google Scholar 

Rhonda K, Kotarinos. Myofascial pelvic pain syndrome in females: Pelvic floor physical therapy for management. UpToDate. Accessed July 7, 2025. https://www.uptodate.com/contents/myofascial-pelvic-pain-syndrome-in-females-pelvic-floor-physical-therapy-for-management

Fitzwater JB, Kuehl TJ, Schrier JJ. Electrical stimulation in the treatment of pelvic pain due to levator Ani spasm. J Reprod Med. 2003;48(8):573–7.

PubMed  Google Scholar 

Nappi RE, Ferdeghini F, Abbiati I, Vercesi C, Farina C, Polatti F. Electrical stimulation (ES) in the management of sexual pain disorders. J Sex Marital Ther. 2003;29(Suppl 1):103–10. https://doi.org/10.1080/713847129.

Article  PubMed  Google Scholar 

Fernández-de-Las-Peñas C, Nijs J. Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res. 2019;12:1899–911. https://doi.org/10.2147/JPR.S154728.

Article  PubMed  PubMed Central  Google Scholar 

Morsy H, Meister M, Spitznagle T, et al. A pilot randomized controlled trial of vaginal cryotherapy for the treatment of pelvic floor myofascial pain. Int Urogynecol J. 2024;35(1):215–25. https://doi.org/10.1007/s00192-023-05692-1.

Article  PubMed  Google Scholar 

Ashtiani EM, Shokouhi N, Mohseni M, Saedi N, Haeri-Mehrizi AA, Bakhtiyari M. A novel radiofrequency modulation therapy versus routine physiotherapy modalities in treatment of myofascial pelvic pain syndrome: a pilot randomized trial. Obstet Gynecol Sci. 2023;66(3):230–40. https://doi.org/10.5468/ogs.22171.

Article  PubMed  PubMed Central  Google Scholar 

Coombs P, Lewis G, Chen AH, Ma Y, Carrubba AR. Does pudendal nerve block improve perioperative pain following OnabotulinumtoxinA injection for myofascial pelvic pain? Eur J Obstet Gynecol Repro

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