Does pelvic floor muscle training improve female sexual function? a systematic review

Ferreira CHJ, Dwyer PL, Davidson M, De Souza A, Ugarte JA, Frawley HC. Int Urogyenecol J (2015) 26:1735-1750.
Pelvic PT Distance Journal Club February 3, 2015
Beth Shelly

Systematic review of 8 RCT which included PFM training and sexual dysfunction.

Pedro scale -  4 or 5 for most studies (one study rated 7) - fair quality - results interpreted with caution

Drop outs - five studies had dropout rates over 15% with one study as high as 52% dropout

Adherence to PFM exercises 19% to 96%

Heterogeneous patients - SUI (3), postpartum (2), POP (2), GYN cancer (1)

Most often sexual function was recorded as a secondary outcome

PFM training varied a lot. Individualized, group, with BF or ES, overflow muscles, home exercises. Unable to draw any conclusions about best PFM exercise prescription.

 Theories on why PFM exercises improve sexual function - currently no consensus

·         stronger superficial PFM - better arousal and orgasm

·         PFM weakness contributes to decreased orgasms

·         increased blood flow and enhanced clitoral sensitivity

Five studies found a significant intergroup difference in at least one sexual variable.

Three studies show no difference

Some of the results included improved

·         total FSFI score, all domains of FSFI

·         sensation of a tighter vagina

·         self confidence

·         libido

·         orgasms

·         decreased pain with penetration

·         improved partner gratification

·         improved sexual function related to decreased UI

 PFM specific changes - in most cases analysis was not completed to show how PFM change related to sexual function change

·         PFM awareness and strength (5)

·         no difference in PFM pressure measurement (1)

·         successful SUI assoc with higher Brink score but this was not related to improved sexual function

Braeken (2015) Pedro 7 - POP

·         medium correlation between improved PFM strength and improved sexual function

·         small correlation between improved PFM endurance and improved sexual function

·         women who described improved sexual function had a greater increase in PFM strength (than those who did not report a improved sexual function)

Level 2 evidence that PFM exercises improve some aspects of sexual function

Grade B recommendation that PFM exercises be used to improve sexual function, consider adherence