Abstract
Background
Sexuality is influenced by a combination of psychological, emotional, and physiological factors, where sexual satisfaction is a key component. Progressive muscle relaxation exercises are commonly used to reduce anxiety and improve physical relaxation, but their impact on sexual satisfaction and function, particularly for individuals with low sexual satisfaction, has not been widely studied. This study aimed to investigate the effect of progressive muscle relaxation exercises applied to women with low sexual satisfaction on the sexual satisfaction and function of both the women and their partners.
Methods
This single-blind, randomized controlled study was conducted from April 2023 to January 2024. The study sample consisted of 120 couples, randomly assigned to either the intervention or control group. Women in the intervention group performed progressive muscle relaxation exercises three times a week for four weeks, while the control group did not receive any intervention. The outcomes measured were sexual satisfaction and sexual function, using the Sexual Satisfaction Scale and the Arizona Sexual Experiences Scale (ASEX), for both the women and their partners.
Results
Significant improvements were observed in the sexual satisfaction scores of both women and their partners in the intervention group, with a statistically significant difference between the groups. In the intervention group, there was a significant increase in sexual satisfaction scores (from 33.12 ± 9.22 to 73.93 ± 6.31) and a marked decrease in ASEX scores (from 14.61 ± 4.51 to 2.71 ± 1.64). In contrast, the control group showed no significant changes in either sexual satisfaction (from 30.17 ± 11.11 to 33.12 ± 9.22) or ASEX scores (from 14.88 ± 3.29 to 12.88 ± 3.11).
Conclusion
The results suggest that progressive muscle relaxation exercises can significantly improve sexual satisfaction and function in women with low sexual satisfaction and their partners, providing a potential intervention for sexual dysfunction.
Keywords: Progressive muscle relaxation, sexuality, sexual satisfaction, sexual disorder
Introduction
Sexuality is a complex, multidimensional concept that encompasses not only gender, sexual orientation, pleasure, and love, but also a range of emotional, psychological, and physical factors. It begins before birth and continues throughout life, shaped by individual values, beliefs, emotions, personalities, behaviors, and the society in which one lives. Sexuality includes not only the genitals but the entire body and mind (Sigurdardottir et al., 2020). Psychological factors, such as emotions, attitudes, and perceptions during sexual experiences, as well as physiological factors like muscle groups (especially the pelvic floor muscles), contribute to the overall sexual experience (Schütze et al., 2022; Zhu et al., 2022).
Sexual satisfaction is generally defined as the degree of contentment an individual experiences with the sexual aspect of their relationship. It is an important component of sexual health and well-being and can be influenced by both mental and physical factors. Sexual satisfaction is not only achieved through interaction with a partner, but also through autoeroticism (masturbation), which can provide a sense of sexual fulfillment and well-being. Sexual dissatisfaction can lead to feelings of inadequacy and insecurity during intercourse, affecting both partners (Franco et al., 2021; Johnson et al., 2016). When sexual satisfaction is compromised, individuals may experience feelings of failure, insecurity, and dissatisfaction, which can negatively affect their quality of life and sexual functioning. These issues are often exacerbated in women who experience pelvic floor dysfunction or muscle tension during sexual activity. The ability to relax the pelvic floor muscles during intercourse is crucial for sexual satisfaction, allowing for more comfort and enhancing sexual pleasure for both partners (Franco et al., 2021; Kaba & Bozkurt, 2020). Thus, improving pelvic floor muscle relaxation is a key focus for addressing sexual dissatisfaction in women.
Progressive muscle relaxation (PMR) is a widely recognized technique that reduces stress, pain, and anxiety through the systematic contraction and relaxation of muscle groups, accompanied by deep breathing exercises. This method helps alleviate tension and promote emotional and physical relaxation (Kaba & Bozkurt, 2020; Min et al., 2022). In particular, PMR may offer significant benefits for individuals experiencing sexual dysfunction or dissatisfaction by targeting the pelvic floor muscles. The technique not only relaxes muscle tension but may also reduce anxiety, which could improve sexual satisfaction and function for both women and their partners. Despite its potential, there has been limited research on the effect of PMR on sexual satisfaction, especially regarding couples.
The rationale for using PMR to address sexual dissatisfaction lies in its potential to reduce anxiety and relieve pelvic floor muscle tension, both of which contribute to sexual dysfunction. This study aims to explore the effects of progressive muscle relaxation exercises on sexual satisfaction and function in women with low sexual satisfaction, as well as their partners.
Given that midwives play a central role in promoting sexual and reproductive health across the lifespan, incorporating accessible, noninvasive interventions such as PMR into midwifery care may enhance the support provided to women experiencing sexual dissatisfaction. Midwives, as frontline providers in women’s health, are uniquely positioned to implement holistic strategies that address both the physical and emotional aspects of sexual well-being.
By examining the physiological and psychological changes resulting from PMR, this study hopes to provide evidence for its efficacy in improving sexual well-being and to support its integration into midwifery practice.
Hypotheses
H1: Progressive muscle relaxation techniques increase sexual satisfaction in women with low sexual satisfaction.
H2: Progressive muscle relaxation techniques positively affect sexual function in women with low sexual satisfaction.
H3: Progressive muscle relaxation techniques increase sexual satisfaction in the partners of women with low sexual satisfaction.
H4: Progressive muscle relaxation techniques positively affect the sexual function of the partners of women with low sexual satisfaction.
Materials and methods
The single-blind, randomized-controlled-type study was conducted between April 2023 and January 2024. The study consisted of a four-week follow-up and intervention period.
Study design
The sample of the study was calculated using G power. Accordingly, Schütze et al. (2022) evaluated the effect of pelvic floor muscle exercises on sexual function in pregnant women. The test result found that there should be a total of 88 participants, 44 for each group. Considering that there would be losses, the sample was planned to be a total of 120 pairs, 60 for each group (Figure 1).
Figure 1.
Consort Diegram.
Inclusion criteria were as follows: Women of childbearing age (18–35 years), sexually active, with the same partner for the past year, no previous childbirth, with a score between 20 and 40 on the New Sexual Satisfaction Scale (indicating low sexual satisfaction), and with a total score of 11 or greater on the Arizona Sexual Experiences Scale (ASEX) indicating sexual dysfunction. All study inclusion criteria were met.
Exclusion Criteria: Women with gynecological diseases and men with Andrological/Sexual Diseases and Men and Men with all metabolic diseases, those using psychiatric medications (themselves or their partners), those who were pregnant at the time of the study, those with diagnoses that impair sexual function such as vaginismus or erectile dysfunction, those with high sexual satisfaction (scores above 40 on the New Sexual Satisfaction Scale), or those with normal sexual function (scores below 11 on the Arizona Sexual Experiences Scale (ASEX)) were excluded from the study.
Randomization and blinding
Participants were enrolled in the study until the minimum required number (1:1 ratio) was reached. A total of 472 women were interviewed; however, 22 women and their partners declined participation. Additionally, 330 couples were excluded for not meeting the inclusion criteria, resulting in a final sample of 120 couples.
Randomization was conducted using the Random Allocation Software (version 1.0) by an independent researcher who was not involved in the study. The participants were randomly assigned to two groups: the Intervention Group (A) and the Control Group (B). At the beginning of the study, group assignments were determined by lottery. Consequently, the study was completed with 120 couples, 60 in Group A and 60 in Group B.
The study’s enrollment, assignment, follow-up, and analysis procedures followed the CONSORT 2018 guidelines (Grant et al., 2018) (Figure 1).
Since the progressive relaxation intervention and follow-up were conducted by the principal investigator (F.Ş.B.), blinding was not possible at this stage. However, to minimize bias, group assignments were managed by an independent academic, and the principal investigator did not participate in pretest, post-test, or statistical analysis. Additionally, the statistician analyzing the data remained blinded to group allocations.
Measurement
The results of the study were obtained through a data collection form consisting of ten questions about sociodemographic and sexual life characteristics of men and women.
The New Sexual Satisfaction Scale (NSSS), developed by Stulhofer et al. (2010) and conducted a Turkish validity and reliability study by Tuğut (2016), was used to include women in the sample and to evaluate their sexual satisfaction during the follow-up period (Soykan, 2004). The scale consists of 20 items. The 5-point Likert scale is scored as (1) Not at all satisfied (2) Somewhat satisfied (3) Moderately satisfied (4) Very satisfied (5) Extremely satisfied. The lowest score that can be obtained from the scale is 20 and the highest score is 100. The scale consists of a self-centered sub-dimension and a co-partner/sexual activity-centered subdimension. These two sub-dimensions represent the New Sexual Satisfaction Scale. The self-centered sub-dimension is items 1-10, and the co-partner/sexual activity-centered subdimension is items 11–20. The scoring of the scale is calculated by adding the items. A high score on the scale indicates that sexual satisfaction is good. There are no items that are scored inversely on the scale. As a result of Cronbach’s alpha reliability analysis for women, the reliability coefficient of the scale was found to be 0.94. The self-centered sub-dimension was calculated as 0.90 and the co-partner-sexual activity-centered sub-dimension was calculated as 0.91. As a result of Cronbach’s alpha reliability analysis for men, the reliability coefficient of the scale was found to be 0.95. It was calculated as 0.93 for the Self-Centered sub-dimension and 0.95 for the co-partner-sexual activity-centered subdimension. In this study, it was found to be 0.961 for women and 0.942 for men. The reliability of the Self-Centered and Coactivity subscales for both women and men was assessed. The Cronbach’s alpha for the Self-Centered subscale was 0.971 for women and 0.944 for men, indicating. Similarly, the Cronbach’s alpha for the Coactivity subscale was 0.95 for women and 0.911 for men, demonstrating. These reliability coefficients confirm the internal consistency of the subscales in both groups.
The researchers used a Turkish-validated version of the Arizona Sexual Experiences Scale (ASEX) is a self-report instrument developed to evaluate an individual’s sexual functioning in a brief and objective manner. The scale consists of two separate forms tailored for men and women. Each form includes five items, with each item scored on a 6-point Likert scale ranging from 1 to 6. The total score ranges from 5 to 30, with higher scores indicating greater impairment in sexual functioning. The women version of the ASEX assesses the following five domains: (1) level of sexual desire, (2) degree of arousal, (3) vaginal lubrication, (4) ease of achieving orgasm, and (5) satisfaction with orgasm. The male version evaluates similar domains—sexual desire, arousal, orgasm ease, and orgasm satisfaction—but replaces the item on vaginal lubrication with an item assessing the ability to achieve and maintain an erection. In this way, the scale accounts for physiological and psychological differences between sexes in its assessment. The presence of sexual dysfunction is determined based on the fulfillment of at least one of the following criteria: a total ASEX score of 11 or higher, a score of 5 or more on any individual item, or a score of 4 or more on three or more items. The scale is administered using the gender-specific version appropriate for each participant, and the scoring and interpretation procedures are applied similarly across both versions (Tuğut, 2016). There are two versions of the scale for men and women. The male form of the scale was administered to men and the women form to women. Scale score calculation and evaluation are performed similarly for men and women.
Recruitment
Participants were recruited through purposive sampling via social media platforms, including Facebook, Instagram, Twitter, and Telegram. The study was announced on these platforms, and individuals who met the inclusion criteria voluntarily expressed interest in participating. Following this, the research team conducted a screening process to verify eligibility based on the pre-established criteria. Eligible participants were then contacted and formally enrolled in the study. No participants dropped out during the study period. The selection process was based on specific characteristics such as sexual satisfaction scores (between 20 and 40 on the New Sexual Satisfaction Scale for women), sexual health criteria (ASEX scores of 11 or above for both men and women), and age range, as defined in the inclusion criteria. Couples who met these criteria were then randomized into two groups. A data collection form was administered to the pairs included in the sample. The setting for sample selection was online platforms, which enabled broad outreach and facilitated efficient participant recruitment.
Intervention
The women in the couples assigned to the Intervention Group were taught progressive muscle relaxation techniques online by the researcher. In addition to the relaxation exercises, the women were also taught deep breathing movements, and progressive muscle relaxation exercises and breathing exercises were performed together. The importance of the exercises and how to do them were explained to the women by the researcher for approximately 30 min, through an online platform. This statement was made individually for each woman. The researcher used a video conferencing tool (Zoom) to demonstrate the techniques and interact with the participants in real time. Each exercise session, which included both progressive muscle relaxation and deep breathing techniques, lasted approximately 20–25 min.
The flow of breathing exercises and progressive muscle relaxation exercises is explained below.
Breathing exercises
-
Initial Sit:
Sit in a comfortable position or lie on your back.
Close your eyes.
Relax your body and relax your shoulders.
Make sure your hands are comfortably placed on your chest (for example, your hands can be on your stomach or knees).
-
Deep Breathing:
Inhale: Take a deep breath through your nose. While inhaling, you will feel the abdomen expand outwards. This phase is for 4 seconds.
Holding Breath: The breath you take is held for 4 seconds. While doing this, you will be careful not to feel any tension, just hold it lightly.
Exhale: Exhale slowly and controlled through your mouth. While exhaling, you will feel the abdomen pull inwards. This phase is for 6 seconds.
Relaxation: After inhaling, relax for a moment and feel the body relax.
-
Counting Your Breaths:
4-7-8 Technique: The 4-7-8 rule is followed in this exercise.
Inhale (4 seconds): Take a deep breath through the nose for 4 seconds.
Hold the breath (7 seconds): Hold the breath for 7 seconds.
Exhale (8 seconds): Slowly exhale through the mouth for 8 seconds.
This cycle is repeated 4–5 times.
-
Slow and Controlled Breathing:
Inhale: Take a deep breath through the nose slowly for 4 seconds.
Exhale: Exhale slowly through the mouth for 6–8 seconds. During this process, focus on the breath and do not allow the mind to wander. The depth and speed of the breath should be natural, care should be taken not to overdo it.
Progressive muscle relaxation exercises
Location: A comfortable place where you can sit or lie down should be chosen.
Focus on Muscle Group: Each muscle group is contracted for approximately 5 seconds and relaxed for 10–15 seconds.
Head and Neck Muscles: The neck is tilted back and the head is pushed upwards. It is tightened for 5 seconds.
Relaxation: Relaxation is achieved by leaving the head and neck relaxed and taking a deep breath.
Facial Muscles: The eyes are closed, the eyebrows are raised and the mouth is opened with a smiling movement.
Relaxation: Release your facial muscles, breathe comfortably.
Shoulders: The shoulders are lifted toward the ears and held tightly.
Relaxation: The shoulders are released, relaxation is felt.
Arms (Forearms and Upper Arms): The forearms are made into tight fists and the upper arm muscles are tightened.
Relaxation: The arms are relaxed and the muscles are released.
Hands and Fingers: The hands are made into a strong fist, the fingers are closed tightly.
Relaxation: The hands and fingers are slowly opened and relaxed.
Chest and Abdominal Muscles: Take a deep breath, inflate the abdomen and expand the chest.
Relaxation: Exhale and relax the abdomen.
Back: Stretch the back upwards and contract the back muscles.
Relaxation: The back is relaxed and relaxed.
Legs (Thighs and Calves): Tighten the thigh muscles and press the legs toward the floor.
Relaxation: The legs are released and the muscles are relaxed.
Calf and Foot Muscles: Pull the toes upwards and contract the calf muscles.
Relaxation: The feet are relaxed and relaxed.
Toes: Press the toes down as far as possible.
Relaxation: Release the toes and relax.
Finishing: General relaxation: The whole body is relaxed, the muscles are felt to relax for a while. Take a deep breath and relax the body for 3–4 seconds, then take a deep breath.
Mindfulness: Observe how you feel at the moment. Focus on feeling your whole body relax and unwind.
The intervention was applied with a fixed frequency of three sessions per week over a four-week period; however, minor variations in the timing of sessions occurred depending on participants’ availability and individual scheduling needs. To ensure adherence to the program, the researcher contacted the women in the intervention group once a week through phone calls or online messaging, providing reminders and offering counseling about the study. The control group continued their daily routines and were followed up.
At the end of the two and four weeks, the New Sexual Satisfaction Scale and ASEX were applied to all women and their partners
Statistical methods
The data of the study were analyzed using the Statistical Package for Social Sciences (SPSS) Version 26.0 program. Descriptive statistics were calculated to summarize the characteristics of the study variables. The difference between categorical variables was evaluated using the chi-square test. The normality of the dependent variables was evaluated using Q-Q plots and the suitability of the variables for normal distribution was tested with the Kolmogorov-Smirnov test. The Independent t-test was applied to compare the means between the two groups and the 95% Confidence Interval (CI) of the difference between the means was also calculated. The analysis of repeated measures was performed using repeated measures ANOVA and Bonferroni correction was applied in post-hoc tests to determine the time at which the differences occurred. In all analyses, a significance level of p < .05 was considered statistically significant.
Ethical considerations
In this research, scientific and universal ethical principles were followed. Ethical approval was obtained before the data collection process in the study (Date: 01.02.2023, No: 2023/19). Informed consent was obtained from the participants regarding participation in the study. The study was registered on ClinicTrials.gov with IDNCT06354283.
Results
Baseline analyses
The baseline characteristics of the women included in the study are described in Table 1. The mean age at first sexual intercourse for the women in the intervention group was 21.10 ± 2.54, while it was 19.45 ± 2.48 in the control group. In addition, the mean frequency of sexual intercourse per week was estimated to be 2.78 ± 1.92 in the intervention group and 2.75 ± 1.84 in the control group. The entire sample was unmarried, and 43.3% of the intervention group and 35% of the control group used condoms. There was no statistically significant difference between the two groups in the descriptive findings (p > .05; Table 1).
Table 1.
Comparison of sociodemographic and sexual life characteristics of women in the intervention and control groups (N = 120).
| Variable | Intervention (n = 60) |
Control Group (n = 60) |
t* Test | p | ||
|---|---|---|---|---|---|---|
| Mean ± SD* | (Min-Max) | Mean ± SD* | (Min–Max) | |||
| Age | 26.51 ± 5.07 | 21.00–35.00 | 27.00 ± 5.26 | 21.00–35.00 | 1.584.50 | .255 |
| Age of initiation of first sexual intercourse | 21.10 ± 2.54 | 16.00–28.00 | 19.45 ± 2.48 | 15.00–27.00 | 1.334.50 | .060 |
| Duration of association with the current partner (years) | 3.20 ± 1.44 | 1.00–5.00 | 2.90 ± 1.31 | 1.00–5.00 | 1.435.00 | .051 |
| Frequency of sexual intercourse (weekly) | 2.78 ± 1.92 | 1.00–8.00 | 2.75 ± 1.84 | 1.00–8.00 | 1.794.00 | .974 |
| Frequency of orgasm (weekly) |
1.41 ± 1.27 |
0.00–5.00 |
1.85 ± 0.50 |
0.00–6.00 |
1.785.00 |
.676 |
| |
n
|
% |
n
|
% |
X2 value |
p
|
| Marital Status | ||||||
| Married | 27 | 45.0 | 31 | 51.7 | 0.534 | .465 |
| Not married | 33 | 55.0 | 29 | 48.3 | ||
| Education status | ||||||
| Basic school | 8 | 13.3 | 5 | 8.4 | 3.332 | .079 |
| High school | 24 | 40.0 | 20 | 33.3 | ||
| University and above | 28 | 46.7 | 35 | 58.3 | ||
| Revenue status | ||||||
| Less | 20 | 33.3 | 14 | 23.3 | 2.116 | .317 |
| Middle | 34 | 56.7 | 36 | 60.0 | ||
| High | 6 | 10.0 | 10 | 16.7 | ||
| FP method used | ||||||
| Oral contraceptives | 18 | 30.0 | 22 | 36.6 | 2.979 | .395 |
| Condom | 26 | 43.3 | 21 | 35.0 | ||
| Withdrawal method (traditional practice) | 16 | 26.7 | 17 | 28.4 | ||
SD: Standard Deviation; t: Independent t Test; X2: Chi Square.
The baseline characteristics of the men included in the study are described in Table 2. The mean age for the men in the intervention group was 28.10 ± 4.58, while it was 28.46 ± 4.65 in the control group. In addition, the mean frequency of sexual intercourse per week was determined to be 3.75 ± 1.21 in the intervention group and 3.86 ± 1.36 in the control group.
Table 2.
Comparison of sociodemographic and sexual life characteristics of partners in the intervention and control groups (N = 120).
| Variable | Intervention (n = 60) |
Control Group (n = 60) |
t*value | p | ||
|---|---|---|---|---|---|---|
| Mean ± SD* | (Min–Max) | Mean ± SD* | (Min-Max) | |||
| Age | 28.10 ± 4.58 | 21.00–35.00 | 28.46 ± 4.65 | 20.00–35.00 | 1.710.50 | .637 |
| Age of initiation of first sexual intercourse | 19.35 ± 2.40 | 15.00–24.00 | 19.63 ± 2.43 | 15.00–25.00 | 1.734.00 | .521 |
| Frequency of orgasms (Weekly) |
3.75 ± 1.21 |
1.00–7.00 |
3.86 ± 1.36 |
1.00–7.00 |
1.734.00 |
.722 |
| |
n
|
% |
n
|
% |
X2 value |
p
|
| Education status | ||||||
| Basic school | 16 | 26.7 | 6 | 10.0 | 5.754 | .056 |
| High school | 14 | 23.3 | 15 | 25.0 | ||
| University and above | 30 | 50.0 | 39 | 65.0 | ||
| Revenue status | ||||||
| Less | 12 | 20.0 | 9 | 15.0 | 6.671 | .051 |
| Middle | 39 | 65.0 | 43 | 71.7 | ||
| High | 9 | 15.0 | 8 | 13.3 | ||
SD: Standard Deviation; t: Independent t Test; X2: Chi Square.
Notably, the weekly frequency of sexual intercourse reported by men was higher than that of their female partners (2.78 ± 1.92 and 2.75 ± 1.84 in the intervention and control groups, respectively). This discrepancy may indicate gender-based differences in the perception, expectation, or reporting of sexual activity. Considering that the study focuses on sexual satisfaction and function among couples, this aspect deserves attention. Such a difference could potentially reflect imbalances in sexual dynamics within the couple and may be relevant to the interpretation of post-intervention outcomes.
There was no statistically significant difference between the two groups at this stage (p > .05; Table 2).
Sexual satisfaction
In the study, the total score of the NSSS for women before the intervention was 32.41 ± 3.44 in the intervention group and 30.17 ± 11.11 in the control group. The total score for the Self-Centered subscale was 17.31 ± 2.54 in the intervention group and 18.03 ± 1.99 in the control group. The total score for the Coactivity subscale was 15.10 ± 2.44 in the intervention group and 12.14 ± 3.43 in the control group. There was no statistically significant difference between the intervention and control groups before the intervention in the total scores of NSSS (p > .05) (Table 3).
Table 3.
Comparison of sexual satisfaction of women and partners in the intervention and control groups (N = 120).
| Intervention Group (n = 60) |
Control Group (n = 60) |
t* value | p | 95% CI | |||
|---|---|---|---|---|---|---|---|
| Mean ± SD* | (Min-Max) | Mean ± SD* | (Min-Max) | ||||
| NSSS*Total Score | |||||||
| Pre-intervention (a) | 32.41 ± 3.44 | 21.00–40.00 | 30.17 ± 11.11 | 21.00–40.00 | 1.432.00 | .111 | 0.092–4.388 |
| 2 Weeks (b) | 54.91 ± 9.92 | 36.00–70.00 | 31.58 ± 13.27 | 20.00–70.00 | 0.284 | .000 | 22.72, 23.94 |
| 4 Weeks (c) | 73.93 ± 6.31 | 60.00–92.00 | 33.12 ± 9.22 | 20.00–70.00 | 657.000 | .000 | 15.06, 51.18 |
| Test | 112.453 | 3.765 | |||||
| p | .000 | .078 | |||||
| Bonferroni | a < c | – | |||||
| Self-centered sub-dimension | |||||||
| Pre-intervention (a) | 17.31 ± 2.54 | 16.00–32.00 | 18.03 ± 1.99 | 15.00–32.00 | 1.443.50 | .764 | −1.545, −0.105 |
| 2 Weeks (b) | 27.40 ± 5.17 | 16.00–50.00 | 16.86 ± 8.01 | 10.00–40.00 | 0.469 | .000 | 8.11, 12.97 |
| 4 Weeks (c) | 45.41 ± 3.95 | 39.00–50.00 | 21.84 ± 3.91 | 20.00–40.00 | 309.000 | .000 | 22.15, 24.99 |
| Test | 115.653 | 4.098 | |||||
| p | .000 | 0.100 | |||||
| Bonferroni | a < b < c | – | |||||
| Co-partner/sexual activity-centered sub-dimension | |||||||
| Pre-intervention (a) | 15.10 ± 2.44 | 12.00–22.00 | 12.14 ± 3.43 | 11.00–23.00 | 1.654.00 | .232 | 1.88, 4.04 |
| 2 Weeks (b) | 27.51 ± 5.41 | 18.00–50.00 | 14.71 ± 6.06 | 10.00–40.00 | 200.000 | .000 | 10.73, 14.87 |
| 4 Weeks (c) | 28.41 ± 4.31 | 18.00–50.00 | 12.28 ± 5.43 | 12.00–40.00 | 320.000 | .000 | 14.36, 17.90 |
| Test | 154.296 | 3.211 | |||||
| p | .000 | .098 | |||||
| Bonferroni |
a < c
|
– |
|||||
| |
Partners of women in the intervention group (n = 60)
|
Partners of women in the control group (n = 60)
|
|
||||
| NSSS* Total Score | |||||||
| Pre-intervention (a) | 36.55 ± 15.45 | 20.00–60.00 | 38.24 ± 11.43 | 20.00–60.00 | 1.342.00 | .187 | −6.60, 3.22 |
| 2 Weeks (b) | 44.78 ± 11.23 | 30.00–60.00 | 39.85 ± 10.36 | 20.00–60.00 | 314.500 | .000 | 1.03, 8.83 |
| 4 Weeks (c) | 68.31 ± 11.24 | 50.00–80.00 | 41.53 ± 9.45 | 20.00–70.00 | 481.000 | .000 | 23.04, 30.52 |
| Test | 123.332 | 1.769 | |||||
| p | .000 | .760 | |||||
| Bonferroni | a < c | – | |||||
| Self-centered sub-dimension | |||||||
| Pre-intervention (a) | 19.53 ± 9.16 | 10.00–40.00 | 19.22 ± 8.10 | 10.00–40.00 | 1.114.00 | .231 | −2.82, 3.44 |
| 2 Weeks (b) | 22.88 ± 6.76 | 20.00–40.00 | 21.63 ± 9.77 | 10.00–40.00 | 421.500 | .000 | −1.78, 4.28 |
| 4 Weeks (c) | 34.06 ± 6.04 | 30.00–50.00 | 20.44 ± 9.21 | 10.00–40.00 | 572.500 | .000 | 10.81, 16.43 |
| Test | 214.980 | 0.783 | |||||
| p | .000 | .886 | |||||
| Bonferroni | a < c | – | |||||
| Co-partner/sexual activity-centered sub-dimension | |||||||
| Pre-intervention (a) | 17.01 ± 7.45 | 10.00–40.00 | 19.02 ± 5.67 | 10.00–40.00 | 1.573.50 | .380 | −4.40, 0.38 |
| 2 Weeks (b) | 21.09 ± 4.98 | 20.00–40.00 | 18.22 ± 6.01 | 10.00–40.00 | 460.500 | .000 | 0.87, 4.87 |
| 4 Weeks (c) | 34.25 ± 5.79 | 30.00–50.00 | 21.09 ± 8.09 | 20.00–40.00 | 504.500 | .000 | 10.63, 15.69 |
| Test | 143.076 | 1.543 | |||||
| p | .000 | .451 | |||||
| Bonferroni | a < c | – | |||||
SD: Standard Deviation; t: Independent t test; * **Analysis of variance in repeated measurements, Group; CI: Confidence Interval; NSSS: New Sexual Satisfaction Scale.
In the partners of the women before the intervention, the total score of the NSSS was 36.55 ± 15.45 in the intervention group and 38.24 ± 11.43 in the control group. The total score for the Self-Centered subscale was 19.53 ± 9.16 in the intervention group and 19.22 ± 8.10 in the control group. The total score for the Coactivity subscale was 17.01 ± 7.45 in the intervention group and 19.02 ± 5.67 in the control group. There was no statistically significant difference between the intervention and control groups before the intervention in the total scores of NSSS (p > .05) (Table 3).
After the intervention, the total score of the NSSS for women was 73.93 ± 6.31 in the intervention group and 33.12 ± 9.22 in the control group. The total score for the Self-Centered subscale was 45.41 ± 3.95 in the intervention group and 21.84 ± 3.91 in the control group. The total score for the Coactivity subscale was 28.41 ± 4.31 in the intervention group and 12.28 ± 5.43 in the control group. In the partners of the women after the intervention, the total score of the NSSS was 68.31 ± 11.24 in the intervention group and 41.53 ± 9.45 in the control group. The total score for the Self-Centered subscale was 34.06 ± 6.04 in the intervention group and 20.44 ± 9.21 in the control group. The total score for the Coactivity subscale was 34.25 ± 5.79 in the intervention group and 21.09 ± 8.09 in the control group. Statistically significant differences were observed in the intra-group comparisons of the intervention group (p = .000), particularly between the total scores of the NSSS, Self-Centered, and Coactivity subscales for both women and their partners. On the other hand, there were no statistically significant differences within the control group for the same variables (p > .05) (Table 3).
Sexual dysfunction
In the study, it was determined that the ASEX total score in women before the intervention was 14.61 ± 4.51 in the intervention group, 14.88 ± 3.29 in the control group, and the partners of the women were 11.83 ± 4.22 in the intervention group and 11.97 ± 3.16 in the control group. There was no statistically significant difference between the ASEX total scores of the women and their partners in the intervention and control groups included in the analysis (Table 4; p > .05). In the study, it was determined that the total score of ASEX in women after the intervention was 2.71 ± 1.64 in the intervention group, 12.88 ± 3.11 in the control group, and 4.67 ± 0.90 in the intervention group and 10.97 ± 3.11 in the control group. In the 2nd and 4th week comparisons of the groups, it was determined that there was a statistically significant difference. In the intragroup evaluation, a statistically significant difference was found between the ASEX total scores of the women in the intervention group (p < .05). There was no statistically significant difference between the ASEX total scores of the women in the control group (p > .05) (Table 4).
Table 4.
Comparison of the sexual functions of women and their partners in the intervention and control group (N = 120).
| ASEX* Total Score | Intervention Group (n = 60) |
Control Group (n = 60) |
Test* Value | p | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Mean ± SD* | (Min–Max) | Mean ± SD* | (Min–Max) | 95% CI | ||||||
| Pre-intervention (a) | 14.61 ± 4.51 | 2.00–11.00 | 14.88 ± 3.29 | 4.00–11.00 | 1.233.00 | .122 | −1.70, 1.16 | |||
| 2 Weeks (b) | 9.62 ± 3.21 | 1.00–9.00 | 12.92 ± 2.42 | 4.00–10.00 | 754.000 | .000 | −4.33, −2.27 | |||
| 4 Weeks (c) | 2.71 ± 1.64 | 1.00–8.00 | 12.88 ± 3.11 | 3.00–11.00 | 199.000 | .000 | −11.06, −9.28 | |||
| Test | 421.411 | 1.222 | |
|||||||
| p | .000 | .121 | ||||||||
| Bonferroni |
a > b > c
|
– |
|
|
|
|||||
| |
Partners of women in the intervention group (n = 60) |
Partners of women in the control group (n = 60) |
|
|
|
|||||
| Pre-intervention (a) | 11.83 ± 4.22 | 5.00–11.00 | 11.97 ± 3.16 | 4.00–11.00 | 1.687.50 | 0.552 | −1.49, 1.21 | |||
| 2 Weeks (b) | 8.33 ± 3.87 | 5.00–10.00 | 10.22 ± 2.99 | 4.00–11.00 | 633.000 | 0.000 | −3.14, −0.64 | |||
| 4 Weeks (c) | 4.67 ± 0.90 | 3.00–8.00 | 10.97 ± 3.11 | 4.00–11.00 | 597.500 | 0.000 | 7.13, −5.47 | |||
| Test | 324.637 | 1.877 | ||||||||
| p | .000 | .543 | ||||||||
| Bonferroni | a > c | – | ||||||||
SD: Standard Deviation; t: Independent t test; * **Analysis of variance in repeated measurements, Group; CI: Confidence Interval; ASEX: Arizona Sexual Experience Scale.
Discussion
While there is a growing body of evidence supporting the effectiveness of non-pharmacological interventions for sexual dysfunction, the specific impact of progressive muscle relaxation (PMR) on sexual health parameters has not been widely explored. To the best of our knowledge, this is the first study to investigate the effect of online PMR intervention on sexual dysfunction and satisfaction in women. This randomized controlled trial aimed to evaluate the effects of online PMR on sexual satisfaction and related parameters in women with sexual dysfunction. Although the primary focus of this intervention was sexual satisfaction, the goal was also to improve broader aspects of sexual well-being.
The findings of this study show that the online PMR intervention resulted in statistically significant improvements in sexual satisfaction and sexual dysfunction scores when compared to the control group. These results suggest that online PMR may be a promising, safe, and effective intervention for improving sexual function in women with sexual dysfunction and their partners.
Sexual dysfunction in women often encompasses various sexual dimensions, such as orgasm, desire, and arousal, which may be influenced by multiple factors. Therefore, many therapies and interventions are designed to address these issues collectively, rather than targeting a single concern (Karaahmet, Sule Bilgic, et al., 2022; Zarbaf et al., 2023; Beji et al., 2003). Exercises that improve muscle tone and circulation, particularly in the pelvic floor muscles, have been shown to positively affect sexual health. The pelvic floor muscles, which are responsible for sexual arousal and clitoral engorgement during arousal, are crucial in sexual function. The PMR intervention may have influenced these physical aspects of sexual function, explaining its impact on sexual satisfaction (Dikmen & Şanlı, 2019; Esenkaya, 2022).
Our study found that PMR intervention was effective in improving sexual dysfunction not only in women but also in their partners. These findings align with previous research that has shown that relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, improve sexual behaviors and satisfaction. For example, one study found that a combination of diaphragmatic breathing, progressive muscle relaxation, and guided visualization improved sexual satisfaction in university students over an 8-week period (Bilgiç & Karaahmet, 2022). Furthermore, studies have shown that pelvic floor exercises also have a positive effect on sexual function (Jha et al., 2018), and hypnotic relaxation therapies have been reported to improve sexual function in postmenopausal women (Zahariou et al., 2008).
However, the literature also contains studies suggesting that pelvic floor exercises do not always lead to improvements in sexual function (Dimou et al., 2014; Karaahmet, Gençturk, et al., 2022; Jangi et al., 2023), possibly due to small sample sizes or variations in intervention protocols. These mixed findings highlight the complexity of sexual dysfunction and the need for larger, more rigorous studies to determine the most effective treatments. Additionally, while the current study provides valuable insights into the potential benefits of PMR, it is important to acknowledge certain limitations.
Firstly, the study’s recruitment process and sample diversity may limit the generalizability of the findings. Future research should aim to include a more diverse sample, including women from various age groups and relationship statuses, to better assess the broader applicability of the intervention. Furthermore, a more detailed exploration of how the online PMR intervention influenced both the psychological and physiological dimensions of sexual function would enhance our understanding of the mechanisms at play.
In conclusion, this study suggests that online progressive muscle relaxation is a promising, noninvasive intervention that can improve sexual satisfaction and function in women with sexual dysfunction. However, further research with larger, more diverse populations is needed to confirm these findings and explore the underlying mechanisms that contribute to the observed improvements in sexual health.
Limitations and strengths
This study has several limitations that should be considered when interpreting the findings. First, the entire sample consisted of unmarried couples. This was not an intentional inclusion criterion but rather a result of the recruitment process. The inclusion of unmarried couples may actually improve the generalizability of the findings, as it reflects contemporary relationship dynamics that are becoming increasingly common. Thus, it is important to note that this does not necessarily limit the study’s applicability to married or more traditional populations, but rather broadens the scope of the findings to include diverse relationship contexts.
Second, the duration and frequency of the progressive muscle relaxation (PMR) intervention were not fully standardized across all participants. While general guidelines were provided, individual differences in adherence and implementation may have influenced the outcomes. Third, the study focused exclusively on women with low sexual satisfaction, which may limit the applicability of the results to broader populations, including women without identified sexual dysfunction or those in different relationship contexts.
Despite these limitations, this study has several strengths. It is the first randomized controlled trial to investigate the effects of an online PMR intervention on sexual satisfaction and function in women. The inclusion of partners’ outcomes adds to the richness of the findings. The single-blind, randomized controlled design minimized potential bias, and the integration of findings from related interventions in the discussion contributes to a more comprehensive understanding of the topic.
Conclusion
This study demonstrates that online progressive muscle relaxation is a promising, noninvasive intervention that can significantly improve sexual satisfaction and reduce sexual dysfunction in women. By integrating such accessible techniques into sexual health care, particularly within the scope of midwifery practice, midwives and midwife counselors may better support women’s sexual well-being. Future studies with larger and more diverse populations are needed to confirm these findings and further explore their applicability in broader clinical and cultural contexts.
Funding Statement
The author(s) reported there is no funding associated with the work featured in this article.
Disclosure statement
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
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