Discrepancy Subjective Sensation and Objective Contraction Strength of Pelvic Floor Muscles: Analysis of Educational Intervention Effects and Individual Differences

Yuichi Nakamura, Manabu Handa, Hitomi Handa
Purpose:

This study aimed to 1) clarify the correlation between subjective sensation and objective contraction strength after an educational intervention and 2) investigate the effects of age on pelvic floor muscle contraction strength.

Methods:

This study included 120 healthy adult women, categorized into four age groups: 20s, 30s, 40s, and 50s and over. Participants’ PFM contraction strength was measured with an ultrasound imaging device after watching an educational video on pelvic floor muscles. Subjective measures included self-reported PFM contraction sensation, muscle contraction difficulty, and PFM function understanding, gathered via questionnaires. Both the subjective scores and the contraction strength were normalized, and the association between them was analyzed with correlation coefficients. Additionally, the standardized gap between subjective awareness and objective contraction strength was analyzed. Analysis of variance was conducted to identify if age significantly affected PFM contraction strength.

Results:

A moderate correlation was observed between subjective awareness of PFM contraction and objective contraction strength (r = 0.36), whereas the correlation between understanding of PFM and objective strength remained low (r = 0.1). Gap analysis revealed that the average difference between subjective awareness and objective contraction strength was nearly zero (2.37E-16), but with a large standard deviation (1.13), thereby indicating considerable individual variation. No significant differences in PFM contraction strength were found across age groups (p > 0.05).

Conclusion(s):

The study revealed that subjective awareness moderately correlates with objective PFM contraction strength, but knowledge or understanding alone does not significantly affect muscle function. The large individual variation in the awareness-function gap indicates the need for personalized feedback and training interventions. Moreover, age-related differences in PFM contraction strength were not significant. Future research is warranted to focus on developing targeted interventions to bridge the gap between subjective perception and actual muscle function, including real-time feedback mechanisms.

Implications:

The results indicate that subjective awareness may not fully reflect actual PFM strength, thereby emphasizing the importance of objective assessment tools, such as ultrasound, in clinical settings. Tailored interventions, including feedback-based training, may help reduce the awareness-function gap and enhance the clinical outcomes in PFM rehabilitation.

Funding acknowledgements:
The authors did not receive support from any organization for the submitted work.
Keywords:
Pelvic floor muscles
Subjective Awareness
ultrasound
Primary topic:
Women's health
Second topic:
Pelvic, sexual and reproductive health
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
The Ethics Review Committee of Sanhuan Tumor Hospital, Chaoyang District, Beijing
Provide the ethics approval number:
SH-2020015
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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