Speakers - 2026

Title: Genitourinary syndrome of menopause: Pelvic floor hypertonicity and physiotherapeutic management of genitourinary pain

Abstract

Introduction

Genitourinary syndrome of menopause (GSM) is a common condition characterized by vulvovaginal and urinary symptoms such as dryness, burning, dyspareunia, and urinary urgency, with a significant impact on quality of life. Traditionally attributed to estrogen deficiency and the resulting mucosal alterations, GSM may also present with pain and dysfunction even in the absence of significant vaginal atrophy. Recent clinical evidence suggests that pelvic floor hypertonicity may represent a relevant co-factor in painful genitourinary conditions, contributing to increased vaginal stiffness, pain modulation, and the onset of functional urinary symptoms.

Recognition of this muscular component opens new therapeutic perspectives, in which pelvic floor physiotherapy plays a central role.

Aim of the Study

To evaluate the relationship between pelvic floor hypertonicity and painful genitourinary symptoms in women undergoing physiological menopause, and to assess the effectiveness of a targeted physiotherapeutic intervention in reducing pain and pelvic dysfunction.

Materials and Methods

This was a prospective observational study with an 8-week physiotherapy intervention and a 3-month follow-up. Women aged 45–55 years in physiological menopause with mild to moderate painful genitourinary symptoms were included. Assessments comprised medical history, validated questionnaires (VHI, FSFI, ICIQ-UI, pain VAS), and physical evaluation of the pelvic floor with analysis of muscle tone.

The intervention consisted of two weekly pelvic physiotherapy sessions including muscle relaxation techniques, manual therapy, biofeedback, breathing and proprioceptive exercises, and postural education.

Results

At baseline, many patients showed pelvic floor hypertonicity associated with genitourinary pain and functional urinary symptoms, even in the presence of mild vaginal alterations. At the end of the intervention, a clinically significant reduction in pain, muscle tone, and trigger points was observed, along with improvements in sexual and urinary function. Benefits were largely maintained at follow-up.

Interpretation of Results

The findings suggest that pelvic floor hypertonicity represents a key factor in painful GSM. Symptom reduction appears to be related to neuromuscular modulation rather than exclusively to estrogen-dependent trophic improvement.

Conclusions

Pelvic floor physiotherapy is confirmed as an effective and complementary approach in the management of painful GSM. Early identification of hypertonicity allows for personalized interventions, improving pain, pelvic function, and quality of life in menopausal women.

This presentation will help clinicians and pelvic health professionals improve their daily practice by providing a broader and more accurate understanding of genitourinary syndrome of menopause, moving beyond the traditional estrogen- deficiency model. The audience will learn to recognize pelvic floor hypertonicity as a key and often overlooked contributor to genitourinary pain, urinary symptoms, and sexual dysfunction, even in the absence of significant vaginal atrophy.

The proposed physiotherapeutic approach offers a practical, evidence-informed, and non-pharmacological solution that can be readily integrated into clinical practice. By incorporating targeted pelvic floor assessment and treatment strategies, this model simplifies clinical decision-making, improves diagnostic accuracy, and reduces the risk of misattributing symptoms solely to mucosal changes. It supports more personalized and effective treatment planning, particularly for women with persistent symptoms despite conventional hormonal therapies.

This approach enhances clinical efficiency by providing clear assessment tools and structured interventions, fosters interdisciplinary collaboration between gynecologists and physiotherapists, and increases clinician confidence in managing complex or atypical presentations of GSM. Ultimately, it leads to improved patient outcomes, including pain reduction, better urinary and sexual function, and enhanced quality of life, while promoting a more comprehensive, precise, and patient-centered model of care.