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“Diagnostic Investigation of the Pelvic Floor”: A Helpful Tool in the Approach in Patients with Complaints of Micturition, Defecation, and/or Sexual Dysfunction


Petra J. Voorham-van der Zalm, Urology, J-3-P, Leiden University Medical Center, PO box 9600, Leiden 2300 RC, the Netherlands. Tel: +31 71 526 388; Fax: +31 71 524 8135; E-mail:


Introduction.  Pelvic floor dysfunction is recognized to be related to lower urinary tract dysfunction and to lower gastrointestinal symptoms, and is an influential factor in dysfunction and subsequent behavior of the genital system in both men and women. Caregivers should be informed regarding normal pelvic floor function in general and should be able to identify specific aspects of pelvic floor dysfunction in patients with related symptoms. In our hospital, this diagnostic consultation is indicated as Diagnostic Investigation of Pelvic Floor Function (DIPFF).

Aim.  This study looked at pelvic floor dysfunction related to specific complaints.

Methods.  DIPFF consists of a medical history, a physical examination, including the International Continence Society (ICS) pelvic organ prolapse quantification system in female patients, and a biofeedback registration using a vaginal or anal probe. Based on our experience, we defined an elevated rest tone as greater than 2 µV using intravaginal or intra-anal electromyography.

Main Outcome Measures.  Stratification of patients with a single complaint, a combination of two or three complaints of the micturition, defecation or sexual (all compartments of the pelvic floor) resulted in subgroups of respectively 30, 74, and 133 patients.

Results.  A total of 238 patients with complaints of micturition, defecation, and/or sexual function were included in this study. Electromyographic analysis revealed an elevated rest tone of the pelvic floor in 141 patients. In 184 patients, we found an involuntary relaxation of the pelvic floor.

Conclusion.  In our retrospective study, we found that 77.2% of patients who presented to the clinic with urinary, gastro or sexual complaints had measurable pelvic floor dysfunction (69.3% overactive rest tone and 7.9% under active rest tone). In relation to the ICS terminology, there is a need for a well-defined normal vs. elevated rest tone of the pelvic floor. Voorham-van der Zalm PJ, Lycklama à Nijeholt GAB, Elzevier HW, Putter H, and Pelger RCM. “Diagnostic Investigation of the Pelvic Floor”: A helpful tool in the approach in patients with complaints of micturition, defecation, and/or sexual dysfunction. J Sex Med 2008;5:864–871.