Pelvic floor muscle failure and impaired vaginal microbiocenosis: results of combination treatment

Background. Pelvic floor muscle failure (PFMF) that is manifested by perineal incompetence is concurrent with vaginal dysbiosis in 79% of cases and often has a polymicrobial etiology, which requires appropriate treatment. Case report. The paper describes a clinical case of a female patient diagnosed with PFMF (N81.8). This patient underwent smear microscopy, pH-metry, and evaluation of pelvic floor muscle strength; questionnaires were used. Treatment was performed, which included the combination drug metronidazole/miconazole/lidocaine/viseptol and stimulator-based pelvic floor muscle training. Treatment for dysbiosis was effective when the above drug was administered; there were no recurrences during the follow-up period. Stimulator-based treatment for PFMF could reduce the frequency and severity of symptoms (from 94.8 to 69.8 PFDI-20 scores; p = 0.03) and dyspareunia (from 80 to 20 visual analogue scale scores; p = 0.03), improve sexual function (from 15.3 to 27.2 FSFI scores; p = 0.001), and prevent progressive PFMF and recurrent dysbiosis. Conclusion. The described clinical case showed that the combination treatment of perineal incompetence with the use of stimulators during the pregravidpreparation period could reduce the incidence and severity of symptoms of stress urinary incontinence and dyspareunia, prevent postpartum progressive PFMF, as well as recurrent vaginal dysbiosis, and improve sexual function.

pelvic floor muscle failure, vaginal dysbiosis, Oxford scale, perineometer, Kegel exercises, vaginal stimulators, metronidazole, miconazole