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. 2025 Nov;36(11):2277-2285.
doi: 10.1007/s00192-025-06190-2. Epub 2025 Jul 2.

Is Pelvic Floor Muscle Resting Activity Associated with Pelvic and Genital Pain, Dyspareunia, and Pelvic Floor Muscle Contraction? A Cross-Sectional Study of Women with Endometriosis

Rakel Gabrielsen  1   2 , Kari Bø  3   4 , Marie Ellström Engh  3   5 , Merete Kolberg Tennfjord  3   6
Affiliations

Is Pelvic Floor Muscle Resting Activity Associated with Pelvic and Genital Pain, Dyspareunia, and Pelvic Floor Muscle Contraction? A Cross-Sectional Study of Women with Endometriosis

Rakel Gabrielsen et al. Int Urogynecol J. 2025 Nov.

Abstract

Introduction and hypothesis: A link between pelvic and genital pain, dyspareunia, and increased pelvic floor muscle (PFM) tone is an area of controversy. Additionally, it has been postulated that increased PFM tone can limit the ability to further activate the PFM. We aimed to investigate the association between PFM resting activity and pelvic and genital pain and dyspareunia, and whether there is an association between PFM resting activity and activation during attempts at PFM maximal voluntary contractions (MVCs) in women with endometriosis.

Methods: This cross-sectional study included 80 women with endometriosis and pelvic and genital pain. An electronic questionnaire included background information, pelvic and genital pain (numeric rating scale 0-10) and questions about location and concerns of dyspareunia. Associations between variables were analyzed using multiple linear regression. PFM resting activity was registered as the mean microvolt (μV) during rest before and between five voluntary MVCs of the PFM.

Results: Mean age was 29 years (SD 6.2), and 9 (11%) were parous. No significant association between resting activity, pelvic and genital pain or location and concerns of dyspareunia was found. A significant positive association between PFM resting activity and activation during attempts at MVCs of the PFM (β = 0.130, p = 0.009, 95% CI = 0.034-0.229) was found.

Conclusion: No association was found between PFM resting activity and pelvic and genital pain or location and concerns of dyspareunia. Contrary to the hypothesis, higher PFM resting activity resulted in more activation of the PFM during attempts at MVCs.

Keywords: Dyspareunia; Endometriosis; Pelvic and genital pain; Pelvic floor muscle activity; Pelvic floor muscle resting activity.

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Conflict of interest statement

Declarations. Ethics Approval: The study was approved by the Regional Medical Ethics Committee (date of approval 22 October 2019; reference number 2019/1236) and the Data Protection Officer at Akershus University Hospital (2019_135). All participants gave written informed consent before data collection began. Conflicts of Interest: None.

Figures

Fig. 1
Fig. 1
Surface electromyography, NeuroTrac MyoPlus Pro Quintet, Bergen, Norway with an Anuform probe and example of curves of pelvic floor muscle (PFM) resting activity and activation during maximal voluntary contraction (mean of five contractions)
Fig. 2
Fig. 2
Dot plot illustrating the association between pelvic floor muscle resting activity and maximal voluntary contraction (MVC) measured using surface electromyography (sEMG). The linear regression line (R2 = 0.181) follows the equation Y = 10.57 + 0.12*X. *n = 75. *Five of the women were not able to insert the probe because of the pain
See this image and copyright information in PMC

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