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Physically, the vulva is an anatomic location of convergence, which includes vascular, neural, hormonal, reproductive, dermatologic, and musculoskeletal systems. Psychosocially, the vulva represents privacy, femininity, sexuality, and intimacy. Because of this intertwined relationship, vulvar disease and dysfunction can significantly impact a woman's physical health as well as her relationships. This article elucidates the impact of vulvar disease on the individual psyche, sexual functioning, and intimate relationships. Psychological concepts are explained, psychological interventions are reviewed, and integrative approaches addressing psychological factors in the clinic are introduced.

Introduction: Sexual pain disorders refer to conditions of genital pain that interfere with intercourse. They often have a musculoskeletal component related to the pelvic floor and are included in the DSM-IV as sexual dysfunctions. Musculoskeletal pain (MP) that is not essentially genitally based often interferes with sex as well yet is not considered a distinct sexual dysfunction. MP is generally addressed by physiatrists, orthopedists, and rheumatologists who are not traditionally trained in sexual medicine, and therefore, the sexual concerns of women with MP often go unaddressed., Aim: The purposes of this review article were to describe how MP is perceived in the literature as affecting sexual function, illustrate how specific MP conditions prevalent in women may affect sexual function, and offer recommendations for clinical practice., Methods: PubMed and Medline searches were performed using the keywords "musculoskeletal pain and sex,""lower back pain and sex,""arthritis and sex," and "fibromyalgia and sex". Main Outcome Measure. Review of the peer-reviewed literature., Results: Most studies cite fatigue, medication, and relationship adjustment as affecting sexuality much as chronic illness does. While musculoskeletal contributors to genital sexual response and pain are considered relevant to sexual function, little is understood about how MP syndromes specifically affect sexual activity., Conclusion: Lack of mobility and MP can restrict intercourse and limit sexual activity, and gender differences are noted in response to pain. Sexual and relationship counseling should be offered as a component of rehabilitative treatment. Physical therapists are uniquely qualified to provide treatment to address functional activities of daily living, including sexual intercourse, and offer advice for modifications in positioning.

Introduction: Chronic pelvic pain (CPP) in women and men is associated with significant sexual dysfunction. Recently, musculoskeletal factors have been recognized as significant contributors to the mechanism of pelvic pain and associated sexual dysfunction, and in particular, pelvic floor muscle hypertonus has been implicated., Aim: The purpose of this Continuing Medical Education article is to describe the musculoskeletal components involved in pelvic and genital pain syndromes and associated sexual dysfunction, introduce specific physical therapy assessment and intervention techniques, and provide suggestions for facilitating an effective working relationship among practitioners involved in treating these conditions., Methods: A review of the relevant literature was performed, clarifying current definitions of pelvic pain, elucidating the role of musculoskeletal factors, and determining the efficacy of physical therapy interventions., Results: A review of the role of physical therapy for the treatment of pelvic pain and related sexual dysfunction., Conclusions: Physical therapy treatment of pelvic pain is an integral component of the multidisciplinary approach to CPP and associated sexual dysfunction.

Introduction: The sphincteric and supportive functions of the pelvic floor are fairly well understood, and pelvic floor rehabilitation, a specialized field within the scope and practice of physical therapy, has demonstrated effectiveness in the treatment of urinary and fecal incontinence. The role of the pelvic floor in the promotion of optimal sexual function has not been clearly elucidated., Aim: To review the role of the pelvic floor in the promotion of optimal sexual function and examine the role of pelvic floor rehabilitation in treating sexual dysfunction., Main Outcome Measure: Review of peer-reviewed literature., Results: It has been proposed that the pelvic floor muscles are active in both male and female genital arousal and orgasm, and that pelvic floor muscle hypotonus may impact negatively on these phases of function. Hypertonus of the pelvic floor is a significant component of sexual pain disorders in women and men. Furthermore, conditions related to pelvic floor dysfunction, such as pelvic pain, pelvic organ prolapse, and lower urinary tract symptoms, are correlated with sexual dysfunction., Conclusions: The involvement of the pelvic floor in sexual function and dysfunction is examined, as well as the potential role of pelvic floor rehabilitation in treatment. Further research validating physical therapy intervention is necessary.