A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction

We commend Torosis et al1 for their study in the April 2024 issue, given the absence of evidence-based guidance to direct treatment for such muscular conditions. However, we express concern regarding the lack of uniform diagnostic terminology, which has implications for the reliability and applicability of the treatment algorithm proposed. Although the article references the landmark article on terminology for pelvic floor muscle assessment (the International Continence Society report), the authors do not use the suggested terms from that report,2 continuing with “high-tone pelvic floor dysfunction” despite the consensus document with a greater number of international experts.2 Multiple systematic reviews in this particular area suggest that the low volume of evidence is hindered by the lack of diagnostic uniformity and terminology used by clinicians and researchers alike.3,4 Without standardized diagnostic criteria and terminology, there is a risk of misdiagnosis, leading to inappropriate or ineffective treatments. It is imperative to improve awareness and recognition of pelvic floor muscular disorders by using widely accepted terminology such as pelvic floor myalgia or pelvic floor tension myalgia.2 In conclusion, although the development of this consensus-based clinical practice guideline for “pelvic floor tension myalgia” (the suggested, correct term) is a significant step forward, not using or addressing the issue of uniform diagnostic terminology impedes meaningful contribution to the literature in a translatable way. We urge further consideration of this aspect in future related research.