(O-38) Paradoxical coexistence of contracture and weakness in women with chronic pelvic pain and dyspareunia

Abstract Background Chronic pelvic pain (CPP) often coexists with pelvic floor dysfunction, combining myofascial contracture and muscle weakness—a paradox that complicates treatment. Objective To assess the coexistence of contracture and weakness in women with CPP and dyspareunia. Methods Prospective study with 49 women randomized to Pelvic Physiotherapy (n = 24) or Mindfulness (n = 25) for eight weekly sessions, followed by crossover. Baseline assessments included physical examination, validated scales, and surface EMG biofeedback. Results All participants had vaginal intracavitary trigger points. Twenty-eight (57%) exhibited paradoxical contraction patterns with weakness (linked to urinary incontinence or contraction failure). Both interventions improved pain and muscle function, with effects sustained at 8–10 month follow-up. Conclusion CPP frequently involves simultaneous contracture and weakness, requiring integrated care. Down-training (myofascial release, relaxation) should precede progressive strengthening and central modulation strategies such as mindfulness to restore neuromuscular function. Keywords: Chronic pelvic pain, dyspareunia, pelvic floor, myofascial contracture, mindfulness. Financing No conflict