Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis

Cristine Homsi Jorge; Kari Bø; Camila Chiazuto Catai; Luiz Gustavo Oliveira Brito; Patricia Driusso; Merete Kolberg Tennfjord

doi:10.1016/j.ajog.2024.01.001

Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis

Am J Obstet Gynecol. 2024 Jan 6:S0002-9378(24)00006-1. doi: 10.1016/j.ajog.2024.01.001. Online ahead of print.

Authors

Cristine Homsi Jorge¹, Kari Bø², Camila Chiazuto Catai³, Luiz Gustavo Oliveira Brito⁴, Patricia Driusso⁵, Merete Kolberg Tennfjord⁶

Affiliations

¹ Pelvic Floor Muscle Function Laboratory, Health Science Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil. Electronic address: cristine@fmrp.usp.br.
² Department of Sports Medicine, Norwegian School of Sports Sciences and Department of Obstetrics and Gynecology, Akershus University Hospital, Nordbyhagen, Norway.
³ Pelvic Floor Muscle Function Laboratory, Health Science Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
⁴ Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, Brazil.
⁵ Women's Health Research Laboratory, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, Brazil.
⁶ Department of Health and Exercise, School of Health Sciences, Kristiania University College, Oslo, Norway.

PMID: 38191016
DOI: 10.1016/j.ajog.2024.01.001

Abstract

Objective: This study aimed to investigate the efficacy of pelvic floor muscle training in treating female sexual dysfunction.

Data sources: A systematic review of databases, including PubMed, Ovid Medline, CINAHL, Embase, BVSalud, Scopus, and Cochrane Library, was performed in July 2021 and updated in May 2023.

Study eligibility criteria: Full-text articles of randomized controlled trials comparing pelvic floor muscle training with no intervention or another conservative treatment were included. At least 1 arm of these trials aimed to improve women's sexual function or treat sexual dysfunction.

Methods: The data for this review were extracted and analyzed by 2 independent reviewers. Data on the characteristics of each intervention were extracted using the Consensus on Exercise Reporting Template. The risk of bias and certainty of evidence were assessed using the Physiotherapy Evidence Database (PEDro) scale and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria, respectively. A meta-analysis was conducted considering the posttreatment mean score difference in the Female Sexual Function Index between the control and treatment groups.

Results: A total of 21 randomized controlled trials were included in this review. The Consensus on Exercise Reporting Template revealed varying quality of the pelvic floor muscle training protocols. Four studies were included in the meta-analysis showing that pelvic floor muscle training improved arousal (1.49; 95% confidence interval, 0.13-2.85), orgasm (1.55; 95% confidence interval, 0.13-2.96), satisfaction (1.46; 95% confidence interval, 0.14-2.77), pain (0.74; 95% confidence interval, 0.11-1.37), and the Female Sexual Function Index overall score (7.67; 95% confidence interval, 0.77-14.57). Very low certainty of evidence due to the data's high clinical and statistical heterogeneity was found according to the GRADE criteria. No side effects of the interventions were reported.

Conclusion: This systematic review and meta-analysis showed that pelvic floor muscle training improved female Female Sexual Function Index total score and several subscales; however, the certainty of the evidence is low.

Keywords: pelvic floor disorders; pelvic floor muscle training; physical therapy; sexual dysfunction; women’s health.

Publication types

Review