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Pelvic floor training shows promise in improving female sexual dysfunction

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Pelvic floor muscle training shows promise in improving female sexual dysfunction | Image credit: © Africa Studio – © Africa Studio – stock.adobe.com.

According to a recent study published in the magazine “The American Journal of Obstetrics and Gynecology.1

findings

  1. Pelvic floor muscle training (PFMT) is associated with improved sexual function, including increased arousal, lubrication, and better orgasm in women.
  2. A systematic review and analysis of randomized controlled trials found that PFMT has positive effects on various aspects of sexual function in many women.
  3. The Female Sexual Function Index is used to assess improvements. Significant gains are reported in several areas, such as arousal, satisfaction and pain relief.
  4. PFMT not only improves sexual function, but also increases body acceptance and communication and reduces symptoms such as dyspareunia and coital incontinence.
  5. Despite the positive results, the certainty of the evidence is very low, indicating that more rigorous studies are needed to better understand the effects of PFMT on female sexual dysfunction.

PFMT has been proposed as a treatment for female sexual dysfunction, with the hypothesis that increased pelvic floor muscle (PFM) strength correlates with improved orgasmic ability and orgasm intensity. Increased blood flow to the PFM may also improve arousal and orgasms.

While sexual dysfunction occurs in 38% to 63% of women, several factors contribute to the underestimation of these conditions. In addition, there is little data to support the hypothesis that PFMT improves sexual function.

Other methods have been shown to be effective in treating sexual dysfunction.2 A Phase 2b study found that sildenafil cream 3.6% (sildenafil cream; Daré Bioscience) is effective in treating female sexual arousal disorder, a condition characterized by the inability to achieve genital arousal during sexual activity.

Sexual function can be assessed using the Female Sexual Function Index (FSFI). The domains of the FSFI include desire, arousal, lubrication, orgasm, pain and satisfaction.1

The researchers conducted a systematic review to evaluate the effects of PFMT on sexual function. The analysis included randomized controlled trials in a population of women with or without sexual dysfunction, using PFMT alone or in combination with other modalities, and comparing it to another treatment modality or placebo.1

The primary outcome was sexual function, with sexual dysfunction defined as: “disturbances of sexual desire and psychophysiological changes that characterize sexual response and cause significant distress and interpersonal difficulties.” PFMT included all programs with voluntary, repetitive PFM contraction.

The PubMed, Ovid Medline, CINAHL, Embase, BVSalud, Scopus and Cochrane Library databases were screened for literature by an experienced research assistant. Titles and abstracts were screened independently by two reviewers, with a third reviewer resolving disagreements.1

Data extraction was performed by 2 independent reviewers. Extracted data included authors, publication year, country, study period, sample size, intervention, follow-up period, outcomes, dropout rate and adherence, and results.

The qualitative synthesis included 21 articles and the quantitative synthesis 4. Considerable heterogeneity was found in outcome measures and types of interventions. Ten studies reported only on pelvic floor dysfunction and only one study included women with sexual dysfunction.1

Eleven studies reported sexual function as the primary outcome. 27% described exercise progress, 18.2% exercise level, and 54.5% exercise adherence. Interventions ranged from PFMT alone to PFMT in combination with other therapies.

A statistical difference in sexual function outcomes between groups was found in 54.5% of studies, with each group favoring PFMT in at least one aspect of sexual function. PFMT was associated with improvements in arousal, lubrication, orgasm, pain, satisfaction, sexual concern, partner pleasure, number of sexually active women, and emotions.1

Other outcomes improved by PFMT included vaginal sexual function/sensation of vaginal flaccidity, body acceptance and rejection, communication, dyspareunia, interference with sexual life due to urinary symptoms, coital incontinence, and sexual quality of life.

Inconsistent results have been reported in postpartum women. One study found improvements in sexual desire, arousal, orgasm, and body acceptance with PFMT, while another study reported improvements in arousal, lubrication, and orgasm.1

One study found no differences in sexual function symptoms between PFMT and control groups. For FSI scores, PFMT was associated with improvements in scores of 1.49 for arousal, 1.55 for orgasm, 1.46 for satisfaction, 0.74 for pain, and 7.67 for the total FSI score. However, the certainty of the evidence was very low.

These results suggest improvement in sexual function with PFMT in a mixed female population. However, the effect size of the intervention is unclear, highlighting the need for further research to clarify uncertainties.1

reference

  1. Homsi Jorge C, Bø K, Chiazuto Catai C, Gustavo Oliveira Brito L, Driusso P, Kolberg Tennfjord M. Pelvic floor muscle training as a treatment for female sexual dysfunction: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 2024;231(1):51-66.E1. doi:10.1016/j.ajog.2024.01.001
  2. Krewson C. Phase 2b study indicates sildenafil cream is effective against female sexual arousal disorder. Contemporary OB/GYN. November 2, 2023. Accessed July 9, 2024. https://www.contemporaryobgyn.net/view/phase-2b-study-indicates-sildenafil-cream-effective-against-female-sexual-arousal-disorder

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