Efetividade de intervenções fisioterapêuticas para o vaginismo: uma revisão da literatura

Vaginismus is an involuntary contraction of the vaginal muscles which makes sexual intercourse difficult or impossible - hence interfering in personal and marital relationships - for which physical therapy strategies have been proposed. The aim of this review was to assess the effectiveness of physical therapy interventions for vaginismus. Clinical trials in which participants were diagnosed with vaginismus were searched for in Scielo and Pubmed databases between 1998 and 2009. Exclusion criteria were: review and transversal studies; studies where patients presented signs and symptoms of vaginismus resulting from other diseases; and studies in which the interventions proposed can't be carried out by physical therapists. Only three studies were found, in which the following therapies were used: Master & Johnson's; sexual cognitive-behavioural therapy plus functional electrical stimulation-biofeedback; and desensitization by silicone dilators. All three studies were evaluated as having poor methodological quality and did not provide consistent evidence for clinical interventions in vaginismus. Due to the scarcity of studies found, no metanalysis was done, only a critical review. No consistent evidence could thus be found on satisfactory clinical physical therapies for vaginismus. Further randomized clinical trials, of high quality, are needed to assess the effectiveness of the treatments proposed.O vaginismo é uma persistente contração involuntária da musculatura da vagina que interfere na penetração, impedindo a relação sexual e podendo comprometer as relações interpessoais e conjugais, para o qual algumas estratégias de fisioterapia têm sido propostas. O objetivo desta revisão foi avaliar a efetividade de tratamentos fisioterapêuticos propostos para o vaginismo. Foram levantados estudos em que o diagnóstico clínico da amostra fosse vaginismo, nas bases de dados Pubmed e Scielo, entre 1998 e 2009. Foram excluídos artigos de revisão, estudos transversais, ou em que as participantes referiam sinais e sintomas de vaginismo decorrentes de outras doenças, ou ainda com intervenções não realizadas por fisioterapeutas. Foram identificados apenas três estudos que se adequaram a esses critérios, em que foram utilizadas as terapias: sexual cognitiva comportamental associada à estimulação elétrica funcional com biofeedback; de dessensibilização por dilatadores de silicone; e a proposta por Masters & Johnson. Os estudos foram avaliados como de baixa qualidade metodológica e não forneciam evidências consistentes para a intervenção fisioterapêutica no vaginismo. Não foi possível efetuar uma metanálise, mas uma revisão crítica, devido à escassez de trabalhos. Portanto, não foram encontradas evidências consistentes de intervenção clínica satisfatória para o vaginismo. Requerem-se estudos clínicos randomizados, de alta qualidade, para comprovar a efetividade dos tratamentos propostos

Heart rate variability and surface electromyography of trained cyclists at different cadences

The heart rate variability (HRV) and surface electromyography (sEMG) are important tools in the evaluation of cardiac autonomic system and neuromuscular parameters, respectively. The aim of the study was to evaluate the behavior of HRV and sEMG of the vastus lateralis in two exercise protocols on a cycle ergometer at 60 and 80 rpm. Eight healthy men cyclists who have trained for at least two years were evaluated. Reduction was observed followed by stabilization of RMSSD and SDNN indices of HRV (p<0.05) along with increases in the amplitude of the sEMG signal (p<0.05) in both protocols. Significant correlations were observed between the responses of HRV and sEMG in the cadence of 60 rpm (RMSSD and sEMG: r = -0.42, p=0.03; SDNN and sEMG: r = -0.45, p=0.01) and 80 rpm (RMSSD and sEMG: r = -0.47, p=0.02; SDNN and sEMG: r = -0.49, p=0.01), yet no difference was observed for these variables between the two protocols. We concluded that the parasympathetic cardiac responses and sEMG are independent of cadences applied at the same power output