• Melanie R Meister, Siobhan Sutcliffe, Chiara Ghetti, Christine M Chu, Theresa Spitznagle, David K Warren, and Jerry L Lowder.
• Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis, MO. Electronic address: meisterm@wustl.edu.
• Am. J. Obstet. Gynecol. 2019 Mar 1; 220 (3): 255.e1-255.e9.

BackgroundPelvic floor myofascial pain is common, but physical examination methods to assess pelvic floor muscles are defined poorly. We hypothesized that a simple, transvaginal pelvic floor examination could be developed that would be highly reproducible among providers and would adequately screen for the presence of pelvic floor myofascial pain.ObjectiveThe purpose of this study was to develop a simple, reproducible pelvic floor examination to screen for pelvic floor myofascial pain.Study DesignA screening examination was developed by Female Pelvic Medicine & Reconstructive Surgery subspecialists and women's health physical therapists at our institution and tested in a simulated patient. We recruited 35 new patients who underwent examinations by blinded, paired, independent examiners. Agreement was calculated with the use of percent agreement and Spearman's rank correlation coefficient.ResultsThe final examination protocol begins with examination of the following external sites: bilateral sacroiliac joints, medial edge of the anterior superior iliac spine, and cephalad edge of the pubic symphysis (self-reported pain: yes/no). The internal examination follows with palpation of each muscle group in the center of the muscle belly, then along the length of the muscle proceeding counter-clockwise: right obturator internus, right levator ani, left levator ani, left obturator internus (pain on a scale of 0-10). Thirty-five patients were enrolled. Correlation was high at each external (0.80-0.89) and internal point (0.63-0.87; P<.0001).ConclusionOur newly developed, standardized, reproducible examination incorporates assessment of internal and external points to screen for pelvic floor myofascial pain. The examination is straightforward and reproducible and allows for easy use in clinical practice.Copyright © 2018 Elsevier Inc. All rights reserved.

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