Female sexual dysfunction (FSD) is a complex, gynaecological disorder and defined as a sexual complaint that results in personal stress or interpersonal difficulties (Campbell & Stein, 2014; Rogers et al., 2018; Wolpe et al., 2017), affect sexual satisfaction, may lead to psychological conflict, affect reproductive health and quality of life. FSD is categorised into sexual arousal disorder, desire disorder, female orgasmic disorder, genito-pelvic pain disorder or pleasure disorder (Campbell & Stein, 2014; Rogers et al., 2018).
Sexual dysfunction has a biopsychosocial aetiology, stemming from a biological, socio-cultural or psychological component (Butt et al., 2019). Factors that may be associated with FSD include several anatomical, psychological, or pathological conditions such as genital mutilation, violence or other harmful practices; endometriosis, gynaecological cancer, urinary infections, reproductive tract infections, urinary incontinence, endocrine alterations, degenerative and vascular diseases (including HIV), psychological problems (e.g., depression) or consumption of psychoactive drugs (Wolpe et al., 2017; World Health Organisation, 2023). An anatomical correlation between pelvic floor muscle (PFM) function and FSD has been suggested due to aging increasing the prevalence of FSD and based on the fact of the association of urinary incontinence with FSD.
Some of the suggested mechanisms of how PFM function is related to FSD, include the following: the weakness of pelvic muscles could contribute to the inability of a woman to achieve orgasm; women who had anorgasmia showed a significantly lower pubococcygeus muscle strength compared with those who had orgasms; an increase in the strength of muscles attached to the corpus cavernosum of the clitoris could lead to increased orgasm and arousal. These hypotheses state that improving pelvic floor muscle (PFM) strength would improve women’s capacity to achieve orgasm or the intensity of orgasm. Increased blood flow to the PFMs would mediate improvement in arousal, lubrication, and orgasm, while an increased body self-perception may enhance women’s ability to relax and contract the PFMs, providing improved vaginal receptivity to penetration and more pleasure for both partners. Very few studies have however investigated these hypotheses.
A randomised controlled trial by de Menezes Franco et al., found that postmenopausal women with sexual dysfunction presented with weakness of the PFM compared to non-menopause women. Sartori et al. (2020) also found a significant relationship between PFM strength parameters and sexual activity. In a cross-sectional study they demonstrated that sexually active women had significantly better PFM endurance than those women who were not sexually active.
Another randomised clinical trial by Zachario et al. (2024) found significant improvement in all the domains of the FSFI in a group of women with Multiple Sclerosis who underwent a 12 week PFM training program compared to a control group. Although these studies are not without limitations, it does give us some evidence of effectiveness and possible causality.
A recent systematic review and meta-analysis by Jorge et al. (2024) showed that pelvic floor muscle training improved the FSFI total score and several subscales’ scores.
The certainty of the evidence is however still low due to methodological limitations and limited high quality studies investigating the PFM’s role in FSD.
Key references
Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018 Oct 4;10(10):CD005654. doi: 10.1002/14651858.CD005654.pub4. PMID: 30288727; PMCID: PMC6516955.
Jorge CH, Bø K, Chiazuto Catai C, Oliveira Brito LG, Driusso P, Kolberg Tennfjord M. Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis. Am J Obstet Gynecol. 2024 Jul;231(1):51-66.e1. doi: 10.1016/j.ajog.2024.01.001. Epub 2024 Jan 6. PMID: 38191016.
Sartori DVB, Kawano PR, Yamamoto HA, Guerra R, Pajolli PR, Amaro JL. Pelvic floor muscle strength is correlated with sexual function. Investig Clin Urol. 2021 Jan;62(1):79-84. doi: 10.4111/icu.20190248. Epub 2020 Nov 9. PMID: 33258326; PMCID: PMC7801170.
Saus-Ortega C, Sierra-Garcia E, Martínez-Sabater A, Chover-Sierra E, Ballestar-Tarín ML. Effect of pelvic floor muscle training on female sexual function: A systematic review protocol and meta-analysis. Nurs Open. 2023 Sep;10(9):5790-5796. doi: 10.1002/nop2.1826. Epub 2023 May 25. PMID: 37232024; PMCID: PMC10416017.
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