(830) Female Dyspareunia: Experience of the Pelvic Floor Rehabilitation Clinic. Observational Study

Introduction Dyspareunia is a multifactorial condition characterized by persistent pain during sexual intercourse (SI), impacting women’s sexual health and quality of life. Physical and Rehabilitation Medicine (PRM) plays a central role in its management, particularly through pelvic floor re-education (PFR) and multidisciplinary strategies integrating pharmacological, psycho-emotional, and invasive approaches. Objective To characterize a population of women with dyspareunia followed in a PRM outpatient clinic at a central hospital in Northern Portugal, describing the main clinical findings and interventions performed. Methods A retrospective observational study was conducted including 104 women followed in a PRM consultation between April 2023 and April 2025. Demographic data, relevant medical history, clinical findings, therapeutic interventions, and treatment responses were collected. Results Among the total sample (N=104), the mean age was 35.3 years (SD ±12.15). The majority were nulligravid (62.1%, N=64), with a mean BMI of 25.2 kg/m2 (SD ±4.86). Menopause was observed in 15.5% (N=16). Relevant comorbidities included anxiety disorders in 39.8% (N=39) and depression in 13.6% (N=14). Secondary dyspareunia was the predominant form (66%, N=68), with superficial pain being most frequent (81%, N=83). Approximately 66% (N=68) of participants classified dyspareunia severity as limiting or impossible (grades II–III on the Marinoff scale). On physical examination, most women (54.4%, N=56) presented no visible alterations upon perineal inspection. In a smaller proportion, fissures, perineal scars, residual hymenal tissue, and cutaneous lesions were identified. The Q-tip test was positive in 48.5% (N=50). Vaginal examination revealed pelvic floor muscle hypertonicity in 75.7% (N=78), with impaired voluntary relaxation. Regarding pharmacological management, topical lidocaine was prescribed to 53.4% (N=55) of women, discontinuation of oral contraceptives in 27.2% (N=28), tricyclic antidepressants in 14.6% (N=15), and topical estrogens in 7.8% (N=8). Approximately 80% (N=81) underwent an individualized and supervised PFR program, including perineal massage, biofeedback, and peripheral neuromodulation. Of these, 67% (N=58) were discharged from PRM consultation after resuming pain-free sexual intercourse or achieving Marinoff grade I. Complementary interventions included botulinum toxin injection into the transversus perinei superficialis and puborectalis muscles (10.7%, N=11). Conclusions The high prevalence of pelvic floor hypertonicity and impaired relaxation highlights the pivotal role of PRM interventions, particularly PFR, as a core strategy in dyspareunia management. Findings suggest that PFR contributes to pain reduction during sexual intercourse. However, the observed benefits should be interpreted with caution, as most patients underwent concurrent treatments. This underscores the multifactorial nature of dyspareunia and the necessity of an integrated, multidisciplinary therapeutic approach. Disclosure No