INTRODUCTION: Impaired coordination, relaxation, and atrophy of pelvic floor muscles (PFMs) may cause various health issues referred to as pelvic floor dysfunction (PFD). In recent years, electromagnetic noninvasive stimulation of the pelvic floor was successfully used to treat PFD symptoms. AIM: This study aims to compare the effectiveness of electrical and magnetic noninvasive stimulation for the treatment of PFD in postpartum women. METHODS: 2 intervention groups treated with high-intensity focused electromagnetic ([HIFEM]; G1) procedure and electrical stimulation (G2) were established along with the control group (G3). Patients received 10 therapies delivered at the hospital (G1; 2-3 times per week) or self-administered at home (G2; every other day) after initial training. The protocol was identical for both modalities. Functionality of the PFM was examined by surface electromyography measurements (maximal voluntary contraction [MVC]; mean MVC; muscle activity at rest; endurance of contraction) while patient's subjective perception of pelvic floor functionality was assessed by Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7) standardized questionnaire. Changes in electromyography values and PFIQ-7 scores were statistically evaluated from baseline to after all treatments. MAIN OUTCOME MEASURE: The main outcome measure was enhancement of PFM activity. RESULTS: In total, 95 patients (G1 = 50; G2 = 25; G3 = 20) participated in the study. The MVC, mean MVC, and endurance were lowered in symptomatic patients. After the treatments, these parameters significantly increased (P < .001) and moved toward the values of healthy population. Electrogenesis at relaxation revealed divergent tendencies in the G1 and G2 groups. PFIQ-7 scores significantly improved in treated patients (P < .001). In general, superior results were documented in the HIFEM group as it reached improvement of electromyography parameters from 48% to 59% (electrical stimulation from 7% to 36%) and similarly the improvement of PFIQ-7 score by 57% (electrical stimulation by 32%). CONCLUSION: This study documented that the HIFEM procedure was significantly more effective than electrical stimulation in treatment of PFD in postpartum women. Both the objective and subjective evaluation indicates more profound effects of magnetic stimulation. Elena S, Dragana Z, Ramina S, et al. Electromyographic Evaluation of the Pelvic Muscles Activity After High-Intensity Focused Electromagnetic Procedure and Electrical Stimulation in Women With Pelvic Floor Dysfunction. Sex Med 2020;8:282-289.

Faculty of Physical Education and Sport Department of Anatomy and Biomechanics Charles University Prague Czech Republic

Hospital Lapino Moscow Russia

Medical Faculty Department of Obstetrics and Gynecology RUDN University Moscow Russia

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Selvan V.A. Single-fiber EMG: a review. Ann Indian Acad Neurol. 2011;14:64–67. PubMed PMC

Bø K., Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85:269–282. PubMed

Ribeiro A.M., Mateus-Vasconcelos E.C.L., Silva TD da. Functional assessment of the pelvic floor muscles by electromyography: is there a normalization in data analysis? A systematic review. Fisioter e Pesqui. 2018;25:88–99.

Raez M.B.I., Hussain M.S., Mohd-Yasin F. Techniques of EMG signal analysis: detection, processing, classification and applications. Biol Proced Online. 2006;8:11–35. PubMed PMC

Salsi G., Cataneo I., Dodaro M.G. Three-dimensional/four-dimensional transperineal ultrasound: clinical utility and future prospects. Int J Womens Health. 2017;9:643–656. PubMed PMC

Braekken I.H., Majida M., Engh M.E. Test-retest reliability of pelvic floor muscle contraction measured by 4D ultrasound. Neurourol Urodyn. 2009;28:68–73. PubMed

García del Salto L., de Miguel Criado J., Aguilera del Hoyo L.F. MR imaging–based assessment of the female pelvic floor. RadioGraphics. 2014;34:1417–1439. PubMed

Angelo P.H., Varella L.R.D., de Oliveira M.C.E. A manometry classification to assess pelvic floor muscle function in women. PLoS One. 2017;12 PubMed PMC

Chamochumbi C.C.M., Nunes F.R., Guirro R.R.J. Comparison of active and passive forces of the pelvic floor muscles in women with and without stress urinary incontinence. Braz J Phys Ther. 2012;16:314–319. PubMed

Faubion S.S., Shuster L.T., Bharucha A.E. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clin Proc. 2012;87:187–193. PubMed PMC

Strohbehn K. Normal pelvic floor anatomy. Obstet Gynecol Clin North Am. 1998;25:683–705. PubMed

Pemberton J., Swash M., Henry M.M., editors. The pelvic floor: its function and disorders. Saunders; London: 2002.

Koenig I., Luginbuehl H., Radlinger L. Reliability of pelvic floor muscle electromyography tested on healthy women and women with pelvic floor muscle dysfunction. Ann Phys Rehabil Med. 2017;60:382–386. PubMed

Voorham-van der Zalm P.J., Voorham J.C., van den Bos T.W.L. Reliability and differentiation of pelvic floor muscle electromyography measurements in healthy volunteers using a new device: the multiple array probe leiden (MAPLe) Neurourol Urodyn. 2013;32:341–348. PubMed

Zhang Q., Wang L., Zheng W. Surface electromyography of pelvic floor muscles in stress urinary incontinence. Int J Gynecol Obstet. 2006;95:177–178. PubMed

Thompson J.A., O’Sullivan P.B., Briffa N.K. Altered muscle activation patterns in symptomatic women during pelvic floor muscle contraction and Valsalva manouevre: altered Muscle Activation Patterns. Neurourol Urodyn. 2006;25:268–276. PubMed

Smith M.D., Coppieters M.W., Hodges P.W. Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurourol Urodyn. 2007;26:377–385. PubMed

Sapsford R.R., Richardson C.A., Maher C.F. Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehabil. 2008;89:1741–1747. PubMed

Pereira L.C., Botelho S., Marques J. Are transversus abdominis/oblique internal and pelvic floor muscles coactivated during pregnancy and postpartum? Neurourol Urodyn. 2013;32:416–419. PubMed

Lauper M., Kuhn A., Gerber R. Pelvic floor stimulation: what are the good vibrations? Neurourol Urodyn. 2009;28:405–410. PubMed

Junginger B., Baessler K., Sapsford R. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J. 2010;21:69–77. PubMed

Gagnon L.-H., Boucher J., Robert M. Impact of pelvic floor muscle training in the postpartum period. Int Urogynecol J. 2015;27:255–260. PubMed

Zuchelo L.T.S., Bezerra I.M.P., Da Silva A.T.M. Questionnaires to evaluate pelvic floor dysfunction in the postpartum period: a systematic review. Int J Womens Health. 2018;10:409–424. PubMed PMC

Radzimińska A., Strączyńska A., Weber-Rajek M. The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: a systematic literature review. Clin Interv Aging. 2018;13:957–965. PubMed PMC

Correia G.N., Pereira V.S., Hirakawa H.S. Effects of surface and intravaginal electrical stimulation in the treatment of women with stress urinary incontinence: randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2014;173:113–118. PubMed

Schreiner L., Santos TG dos, Souza ABA de. Electrical stimulation for urinary incontinence in women: a systematic review. Int Braz J Urol. 2013;39:454–464. PubMed

Samuels J.B., Pezzella A., Berenholz J. Safety and efficacy of a non-invasive high-intensity focused electromagnetic field (HIFEM) device for treatment of urinary incontinence and enhancement of quality of life. Lasers Surg Med. 2019;51:760–766. PubMed PMC

Hlavinka T., Turcan P., Bader A. The use of HIFEM technology in the treatment of pelvic floor muscles as a cause of female sexual dysfunction: a multi-center pilot study. J Womens Health Care. 2019;08

Alinsod R., Vasilev V., Yanev K. Hifem technology a new perspective in treatment of stress urinary incontinence. Lasers Surg Med. 2018;50:S4–S56. PubMed

Omar A., Marwaha K., Bollu P.C. StatPearls. StatPearls Publishing; Treasure Island, FL: 2019. Physiology, neuromuscular junction.http://www.ncbi.nlm.nih.gov/books/NBK470413/ Available at: PubMed

Faraday M.V. Experimental researches in electricity. Philos Trans R Soc Lond. 1832;122:125–162.

Kanjanapanang N., Chang K.-V. StatPearls. StatPearls Publishing; Treasure Island, FL: 2019. Peripheral magnetic stimulation (transcutaneous magnetic stimulation)http://www.ncbi.nlm.nih.gov/books/NBK526087/ Available at: PubMed

Mehler B., Larsson K.M. Electromyographic (EMG) biofeedback in the treatment of pelvic floor disorders. In: Mostofsky D.I., editor. The handbook of behavioral medicine. John Wiley & Sons, Ltd; Oxford, UK: 2014. pp. 313–338.

Barber M.D., Kuchibhatla M.N., Pieper C.F. Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol. 2001;185:1388–1395. PubMed

De Luca C.J. The use of surface electromyography in biomechanics. J Appl Biomech. 1997;13:135–163.

Coletta N.A., Mallette M.M., Gabriel D.A. Core and skin temperature influences on the surface electromyographic responses to an isometric force and position task. PLoS One. 2018;13:e0195219. PubMed PMC

Basmajian J.V., Luca C.J.D. Williams & Wilkins; Baltimore: 1985. Muscles alive: their functions revealed by electromyography. Subsequent edition.