A pilot randomized trial of a telehealth pelvic yoga program for women with chronic pelvic pain

Abstract Introduction One in seven women suffer from chronic pelvic pain (CPP), a syndrome associated with decreased sexual desire, decreased enjoyment of sexual activity, and increased conflict with sexual partners. Pelvic yoga has been recommended as a complementary community-based management strategy for CPP, given its potential to address multiple contributors to this complex pain syndrome. However, it is unclear whether pelvic yoga instruction can be delivered in a way that is accessible and acceptable for diverse women with CPP in the community. Objective To evaluate the feasibility of a telehealth-based pelvic yoga program for women with CPP and examine preliminary changes in pain-related sexual and overall functioning with yoga instruction and practice. Methods The Program to Overcome Pelvic Pain studY (POPPY) is a pilot randomized trial of a telehealth-based pelvic yoga program designed by an expert yoga panel to address multiple contributors to CPP in women. From 2020 to 2022, women who reported pelvic pain for at least 6 months and at least 4 out of 10 on a pain severity scale were recruited from multiple communities in northern California and randomly assigned in a 1:1 ratio to the telehealth-based study yoga program or an equivalent-time stretching-strengthening control program. Women in the yoga program participated in twice-weekly group videoconference yoga classes supplemented by weekly individual practice of study-specific Hatha yoga techniques; women in the control group took part in equivalent-time group classes and individual practice of general muscle stretching-strengthening exercises that avoided engaging the pelvic floor. Structured diaries and questionnaires assessed participants’ adherence and self-efficacy in practicing intervention techniques as well as their pain-related functioning after 2 months of intervention instruction and another 2 months of maintenance practice. Results Among 36 women randomized over 3 intervention waves (12 women per wave), mean age was 51 (range 27 to 77) years, 33% self-identified as racial or ethnic minorities, and 81% were married or had sexual partners. Eighty-six percent completed the 2-month intervention programs; of these, 87% completed at least 14 of 16 group telehealth classes. Among women completing yoga instruction, 86% felt it was easier to attend yoga classes by telehealth rather than in person. The yoga intervention was associated with improvements in multiple domains of the validated Impact of Female Chronic Pelvic Pain Questionnaire (IFCPPQ), with mean (SD) scores on the IFCPPQ sexual impact subscale decreasing 12.0 (±25.4) points after 2 months of yoga instruction (P=.15) and 20.0 (±21.2) points after another 2 months of maintenance practice (P=.02). Modest improvements in multiple IFCPPQ domains were also observed in the stretching-strengthening control group, although changes in IFCPPQ sexual impact scores did not reach statistical significance among controls (Table 1). Conclusions Findings demonstrate the feasibility of engaging women with chronic pelvic pain in a telehealth-based pelvic yoga program and provide preliminary evidence of improvement in pelvic pain-related sexual function associated with yoga practice. If yoga can be taught in a way that is appropriate and accessible to diverse women in the community, it may offer a promising complementary management strategy for CPP. Disclosure No