WOMEN´S SEXUAL FUNCTION IS IMPROVED BY PELVIC FLOOR MUSCLE TRAINING: A SYSTEMATIC REVIEW WITH METANALYSIS

C. Homsi Jorge¹, P. Driusso², K. Bo³, C. Chiazuto Catai⁴, L.G. Oliveira Brito⁵, M. Tennfjord Kolberg⁶

¹Ribeirão Preto Medical School, University of São Paulo, Health Science, Ribeirão Preto, Brazil, ²Federal University of São Carlos, São Carlos, Brazil, ³The Norwegian School of Sports Sciences. Oslo, Arkershus University Hospital, Lorenskog, Department of Obstetrics and Gyneecology, Oslo, Norway, ⁴Ribeirão Preto Medical School, University of São Paulo, Health Sciences, Ribeirão Preto, Brazil, ⁵State University of Campinas, Gynecology and Obstetrics, Campinas, Brazil, ⁶School of Health Sciences, Kristiania University College, Health and Exercise, Oslo, Norway

Background: Although a systematic review published in 2015 (Ferreira et al. 2015) suggested a positive effect of pelvic floor muscle training (PFMT) to improve sexual function in women, no meta-analysis has been done to confirm this benefit. Purpose: To investigate the efficacy of PFMT to enhance female sexual function.

Purpose: To investigate the efficacy of PFMT to enhance female sexual function.

Methods: This is a systematic review with meta-analysis registered at PROSPERO (CRD42021230505). Inclusion criteria were full-text articles of RCTs of interventions involving PFMT in at least one arm to improve female sexual function published after the year 2000. The search was last updated in December 2022 in Pubmed, Ovid Medline, CINAHL, EMBASE, BVS (LILACS), Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) and PEDro database. The data were extracted using a data collection form and analyzed by two independent reviewers. Risk of bias was assessed using the PEDro scale. A meta-analysis was carried out considering the control and treatment groups, and two measures for each group. To measure heterogeneity, the I2 measure and the Q-test were used. The significance level adopted in the tests was 0.05 and 95% confidence intervals.

Results: Twenty two RCTs published between 2000 and 2022 were included in this review. The number of the participants in the studies varied from 34 to 374. The samples comprised heterogeneous populations in relation to presence of pelvic floor dysfunction (PFD). Ten studies (45.4%) included only participants with PFD. Age-ranged from 18 to 65.2 years old. Types of control and active intervention varied in the studies. Sexual function was the primary outcome in 11 (50%) RCTs. The interventions ranged from individualized supervised PFMT alone to PFMT added to other therapies, most of the studies did not report the intensity of PFM contractions. Training duration varied from 1 month to 1 year. The amount of supervision ranged from one session of instructions to weekly sessions of PFMT over six months. The statistical comparison between groups was not presented in all studies. Twelve (54.5%) of the 22 RCTs found a statistical difference between groups favoring PFMT in at least one aspect of sexual function. The risk of bias varied from low to high with a PEdro score between 4-8. Only five studies using a validated questionnaire (FSFI) were included in the meta-analysis, showing an improvement of the total FSFI score (0.59; 95%CI 0.03 to 2.36; I² 95.4%) and arousal (0.57; 95%CI -0.12 to 2.12; I² 95.1%). A subgroup analysis of 4 trials, excluding 1 trial of women with multiple sclerosis indicated an improvement in the total and all domains scores of the FSFI in favor of PFMT. No side effects of the interventions were reported.

Conclusions: This systematic review with meta-analysis indicated the efficacy of PFMT to improve female sexual function.

Implications: PFMT should be recommended as a first-line intervention to improve female sexual function. Further high quality RCTs are necessary to investigate the effect size of the intervention in specific groups of women, with and without PFD, sexual dysfunction and neurological diseases .

Funding acknowledgements: To São Paulo Research Foundation- FAPESP 17/16262-5 and FAEPA.

Keywords:
Pelvic floor muscle training
Sexual function
Women

Topics:
Pelvic, sexual and reproductive health

Did this work require ethics approval? No

Reason: It is a systematic review of the literature not involving data collection using humans or animals