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‘I am not sure why I was referred for physiotherapy’

It is not uncommon for a woman, and sometimes the physiotherapy practitioner, to question the reason for referral by a gynaecologist. Whilst most of this would boil down to poor communication, the question also stems from poor understanding of the role of physiotherapy in managing some common gynaecological conditions as an adjunct to surgical and medical management. As a gynaecological cancer specialist, I have routinely referred women for allied health support for many years. But it was not until I reviewed the literature for a presentation on survivorship issues experienced by women who have received treatment for gynaecological cancer did I realise how poorly do we address quality of life issues in women undergoing gynaecological surgery for benign conditions. Here are some common scenarios from my practice that prompt a referral to physiotherapy team. 

What is the role of pelvic floor physiotherapy in management of sexual dysfunction?

Sexual dysfunction in women can have varied presentations and even more varied causative factors. The presentation of sexual dysfunction can present in the form of decreased libido, painful intercourse to severe myofascial pain resulting in intense contraction of pelvic muscles that precludes intercourse (vaginismus). Pelvic floor rehabilitation is an important aspect of treatment as an adjunct to managing any organic cause of pain or once an organic cause has been ruled out. 

What are the common reasons for physiotherapy referral after pelvic surgery?

As many as 1 in 2 women undergoing hysterectomy for causes other than pelvic organ prolapse have pre-existing bladder dysfunction and a significant proportion of these women report long term bladder related morbidity following the surgery. The proportion of bladder and bowel related morbidity is even higher in women undergoing radical hysterectomy for gynaecological cancer. Early referral for pelvic floor physiotherapy is the key to addressing the poor quality of life related to bladder and bowel dysfunction. 

How common is lymphoedema in women undergoing surgery for gynaecological cancer?

Depending on how lymphoedema is defined, and there is no universally accepted standard of diagnosis, as many as 1 in 6 women have self reported lower limb lymphoedema (LLL) at diagnosis of gynaecological cancer. The incidence may not be much different in women diagnosed with benign conditions. After surgery for gynaecological cancer, the incidence of LLL can be as high as 1 in 2 at 2 years from surgery. Additional treatments like pelvic radiotherapy add to the risk of developing LLL in gynaecological cancer survivors. 

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