Abstract
Background:
Sexuality is one of the most important elements of an individual’s life. Pelvic floor muscles play a role in sexual function. This study aimed to evaluate the effect of pelvic floor muscle exercise on sexual function in women of reproductive age.
Methods:
A randomized controlled trial was conducted in women of reproductive age. 77 women were randomly assigned to control (n = 39) and training (n = 38) groups. Pelvic floor muscle exercise training was provided to women in the training group, and the Female Sexual Function Index (FSFI) was applied to both groups in the 1st, 2nd, and 3rd months.
Results:
There was no difference in the total FSFI scores between the groups at baseline and 1 month later. In the 2nd and 3rd month evaluations, there was a difference between the groups in the FSFI total score (P = .017; P = .001). In the in-group evaluation of the training group, the difference in the total FSFI score and all subscales except orgasm emerged in the 3rd month (P < .05). In the orgasm subscale score, a significant difference was found in the 1st month (P = .001).
Conclusion:
The results of this study showed the positive effect of regular pelvic floor exercise on sexual health. The effects on all subdimensions of the sexual health scale were found to occur in 6 weeks. Different studies have emphasized that pelvic floor muscle exercise affects sexual health. However, there are few studies conducted with women of reproductive age. Study results show that Regular pelvic floor exercise had a positive effect on sexual function. Incorporating these exercises into sexual health education programs for women could improve their sexual health.
Keywords: exercise, pelvic floor muscle, reproductive age, sexual function
1. Introduction
Sexual function is one of the fundamental elements of quality of life that reflects women’s biological, emotional, and social well-being, and a healthy sex life is an important part of a person’s overall health.[1,2] Female sexual dysfunction is a progressive and common problem affecting 40% to 50% of women, and its incidence increases with age.[3,4] The World Health Organization defines sexual dysfunction as ‘various ways in which an individual is unable to participate in a sexual relationship as he or she would wish.[5]
Sexual function is related to factors such as the absence of pain and discomfort during sexual intercourse, the absence of physiological problems, a healthy sexual response cycle (sexual desire, arousal, orgasm, and resolution), and subjective satisfaction with sexual function and behavior.[6,7] Sexual dysfunction affects not only the individual but also couples. Satisfaction and happiness in sexual relations play an important role in experiencing family stability. Therefore, impairments in sexual function can affect a woman’s quality of life and psychology, as well as negatively impact harmony and happiness between partners.[8] Sexual dysfunction is important in terms of reproductive health. In general, sexual function is considered part of sexual health and reproductive health. The effects of sexual function not only affect individuals’ pleasure and satisfaction but also significantly impact their reproductive capabilities. Therefore, it is important to eliminate the factors causing sexual dysfunction to protect the sexual function of women of reproductive age.[9,10] Sexual dysfunction, which has a negative impact on women’s physical and mental health, can be influenced by many factors. Disorders in sexual organs or hormonal balance, some medications, negative sexual experiences, intense stress, depression, and weakness of the pelvic floor muscles can cause sexual dysfunction.[11–13] Kegel stated that weakness in the pelvic floor muscles may lead to sexual dysfunction.[14] Pelvic floor muscles, levator ani, bulbocavernosus, and ischiocavernosus muscles are the anatomical structures directly affect sexual function and regulate the motor response during vaginal penetration and orgasm, and the strength of these muscles increases lubrication, arousal, and orgasm.[15,16] In women of reproductive age, factors such as vaginal birth, constipation, and excessive and prolonged exercise may weaken the pelvic floor muscles. Constant straining due to constipation can result in pudendal nerve damage.[17,18] During long-term and high-intensity training, pelvic floor muscles cannot relax properly and are constantly in contraction, which can lead to long-term dysfunction in the long run.[19] Excessive increase in the tone of these muscles causes sexual pain disorders. Pelvic floor muscle exercises to relax the hypertonic pelvic floor muscles relax the pelvic floor muscles, improve vaginal flexibility and muscle awareness, and normalize muscle activity at rest. The pubococcygeus and iliococcygeus muscles are very important for involuntary contraction, reaching maximum tension, and then relaxing during sexual arousal, especially during female orgasm.[20,21] Moreover, hypotonia in these muscles can cause vaginal sensitivity, decreased orgasmic intensity, and urinary incontinence during sexual intercourse. Studies have reported different physiological mechanisms related to the impact of floor muscles on sexual health. According to Kegel, pelvic floor muscle weakness can cause women to be unable to reach an orgasm. Therefore, pelvic floor muscle exercises can positively affect the sexual lives of women.[14,22,23] Numerous studies have reported that an increase in the strength of the muscles attached to the corpus cavernosum of the clitoris may lead to better involuntary contraction of the pelvic floor muscles and, therefore, an increase in the arousal and orgasm response. This is possible by increasing the strength of the muscles connected to the corpus cavernosum of the clitoris through pelvic floor muscle exercises, resulting in better involuntary contractions, increased arousal, and orgasmic response, as well as increased blood flow to the pelvis.[2,21] Increased blood flow to the pelvis and clitoral sensitivity have also been suggested.[24–26] The sample of studies evaluating the effects of pelvic muscle exercise on sexual health included menopausal women and those in the postpartum period. No studies have been conducted on women of reproductive ages. However, since reproductive age is a sexually active period, factors affecting sexual function during this period when couples want to have children should not be overlooked. This study aimed to evaluate the effect of pelvic floor muscle exercise on sexual function and how long it takes for the effect of regular pelvic floor muscle exercise on sexual function.
2. Methods
This study was conducted using a prospective, randomized controlled design.
2.1. Sample selection
The sample size required for the study was calculated using G*Power 3.1 software based on a randomized controlled study by Nazarpour et al,[27] on the effects of sexual counseling and pelvic floor relaxation on sexual function in women receiving vaginismus treatment. Their study revealed that the mean FSFI score was 21.40 ± 1.11 before pelvic muscle training was 27.41 ± 0.95 after the training. Based on the results of this study, the difference between these mean scores was taken as the basis, and the effect rate was determined as 0.80 in the statistical analysis. The sample size was determined as 68 participants, including 34 in the experimental group and 34 in the control group at a confidence interval of 95%, margin of error of 5%, effect size of 0.80, and power of 90%. However, considering possible data loss, 40 individuals were included in each group. Data were collected using Google Forms on social media platforms. Women who voluntarily participated in the study were invited to participate and asked to provide written consent. Eighty women who agreed to participate were included in this study. Participants (n = 80) were randomly divided into 2 groups (training [n = 40] and control [n = 40]) using a computer program. However, 2 women in the training group and 1 woman in the control group failed to complete the forms and withdrew from the study. The study sample consisted of 77 women, with 38 in the training group and 39 in the control group.
2.2. Randomization
The study protocol was created using the SPIRIT guidelines, and study reporting was created according to the CONSORT checklist. To avoid selection bias, patients were assigned to the training and control groups using the block randomization method. The n = 80 samples included in the study were randomly divided into training (n = 40) and control (n = 40) groups with the help of the “Random Allocation Software” computer program.
2.3. Inclusion criteria
Being aged 18 to 49
Having not entered menopause
To be sexually active (intercourse 1 to 2 times a week)
Having digital literacy at the basic level (since online training was provided and the scale forms were administered online)
2.4. Exclusion criteria
Women who were not sexually active, who had undergone an operation that prevented them from performing pelvic floor muscle exercises, and who performed long-term and high-intensity exercises because they could strengthen the pelvic muscles and affect the results of the study were excluded from the study. Women who had experienced menopause were excluded from the study. In addition, women diagnosed with gynecological cancer, pelvic floor disorders, or mental health problems were not included in the study.
2.5. Research process
This study was conducted between November 1, 2021, and May 6, 2022. The purpose of the study was explained to the women, and those between the ages of 18 to 49 were invited to participate on social media platforms. The level of sexual function was determined by implementing the FSFI in all participants. The pelvic floor muscle exercise training was provided to the training group. The trainings were given online because of the COVID-19 pandemic and were repeated 3 times once a month. There are both advantages and disadvantages to conducting studies online. One disadvantage is the requirement for digital literacy. However, there are many advantages. This online study has enabled participants to access the research from anywhere. It has also provided participants with advantages in terms of time. In addition, it has ensured that reminder exercise brochures reach the training group quickly and easily. Furthermore, the fact that all forms are digital and not printed on paper has contributed to the protection of trees and the ecosystem.
The training group was divided into 4 subgroups. The 3 subgroups consisted of 10 people, and 1 group consisted of 8 people. The training sessions were conducted online on different days. Each training session lasted 120 minutes. Seventy minutes of training included theoretical information, 30 minutes included watching videos about the application of pelvic floor muscle exercises, and the last 20 minutes included taking the questions of the participants on the subject and answering these questions. The participants were encouraged to ask questions about how to find the pelvic muscles, how to perform the exercise, and how often to evaluate whether the subject was clearly understood. After the women in the training group completed the training, they were asked to perform 3 sets of 8 to 12 repetitive pelvic floor muscle contractions every day and record their practice in an exercise diary (Fig. 1). The study was based on the criteria of performing the exercise every day, 3 times a day, and performing at least 8 repetitions in each exercise. It was planned that the data of women who did not fulfill these criteria would not be included in the study. The women in the training group were also given a booklet and video recording of online training. A brochure explaining how to perform PFM exercises was sent to the training group on the first day of each week. After the training, the FSFI was applied to both groups (who received and did not receive the training) 3 times in the 1st, 2nd, and 3rd months. After the study was completed and all data were collected, the control group also received pelvic floor muscle exercise training and all brochures given to the training group during the study process.
Figure 1.
Exercise diary.
2.6. Data collection
2.6.1. Woman information form
The form was prepared by the researcher based on a similar literature review and consisted of 23 questions about women’s sociodemographic characteristics, general health status, and obstetric characteristics.
2.6.2. Female sexual function index (FSFI)
This scale was developed by Rosen et al (2000) to evaluate sexual function.[28] It includes 19 multidimensional items that evaluate desire, arousal, lubrication, orgasm, satisfaction, and pain. Items were answered based on the previous 4 weeks. Items 1 and 2 evaluated the frequency and level of sexual desire; items 3 to 6 evaluate the frequency and level of arousal, sureness, and satisfaction; items 7 to 10 assess the frequency and difficulty of lubrication and frequency and difficulty of maintaining this lubricity during sexual intercourse; items 11 to 13 evaluate the frequency and difficulty of orgasm and satisfaction; items 14 to 16 evaluate satisfaction, closeness with the spouse, level of satisfaction during sexual intercourse, and overall sexual life; and items 17 to 19 evaluate dyspareunia. The highest and lowest scores on the index were 36 and 2, respectively. An increase in the scores on the total index and sexual desire, arousal, lubrication, orgasm, and general satisfaction subscales indicated an improvement in all these parameters. A Turkish validity and reliability study of the index was conducted by Aygin et al[29] who determined that the Cronbach α coefficient of the total scale was 0.95. In this study, Cronbach α coefficient was determined to be 0.88 in this study.
2.6.3. Training content
The content of the training, which was prepared based on the literature review, included the pelvic anatomy, importance and benefits of pelvic floor muscle exercises, how to perform pelvic floor muscle exercises, determination of the correct muscles, and points to be taken into consideration during the exercise. It also included information about how often exercise should be performed and the importance of doing so regularly. Opinions of at least 3 experts regarding the training content were obtained, and the training content was revised based on expert opinions.
2.6.4. Ethical considerations
This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Scientific Research Ethics Committee of a private university (YDU/2021/96-1428), and written consent was obtained from all participants before the study. The study was registered with ClinicalTrials.gov (NCT06338371).
2.6.5. Statistical analyses
SPSS 26.0 software was used for statistical analysis of the data. Frequency distributions (number, percentage) for categorical variables and descriptive statistics (mean and standard deviation) for numerical variables were provided in the data assessment. The normal distribution of the data belonging to numerical variables was evaluated using the Shapiro–Wilk normality test. The numerical variable data were not normally distributed. Therefore, the Mann–Whitney U test was used for variables belonging to the groups. The Friedman test was used to determine the changes in measurements according to time within the group. Statistical significance was set at P < .05. The effect sizes are reported as partial η2. Accordingly, η2 > 0.01 is interpreted as low, η2 > 0.06 as medium, and η2 > 0.14 as high.[21]
3. Results
The findings of the study revealed that the mean age of the women was 36.82 ± 6.06 in the training group was 36.47 ± 5.98 in the training group. In the control group, 94.87% of the women were married and 12.82% had an income less than their expenses. 89.47 of the women in the training group, 89.47% were married and 13.16% had an income less than their expenses. While 58.97% of the women in the control group stated that they had not heard of pelvic floor muscle exercises before, this rate was 57.89% in the training group (Table 1).
Table 1.
Sociodemographic characteristics of the women: Nicosia, Cyprus, 2022.
| Control (n = 39) | Training (n = 38) | |||
|---|---|---|---|---|
| n | % | n | % | |
| Age (mean ± SD) | 36.82 ± 6.06 | 36.47 ± 5.98 | ||
| Educational background | ||||
| High school and below | 6 | 15.38 | 9 | 23.68 |
| University | 33 | 84.62 | 29 | 76.32 |
| Marital status | ||||
| Single | 2 | 5.13 | 4 | 10.53 |
| Married | 37 | 94.87 | 34 | 89.47 |
| Employment status | ||||
| Employed | 34 | 87.18 | 29 | 76.32 |
| Unemployed | 5 | 12.82 | 9 | 23.68 |
| Income status | ||||
| Income < expenses | 5 | 12.82 | 5 | 13.16 |
| Income = expenses | 23 | 58.97 | 27 | 71.05 |
| Income > expenses | 11 | 28.21 | 6 | 15.79 |
| BMI (mean ± SD) | 24.32 ± 4.53 | 25.15 ± 4.26 | ||
| Smoking | ||||
| Smoker | 10 | 25.64 | 11 | 28.95 |
| Nonsmoker | 29 | 74.36 | 27 | 71.05 |
| Alcohol use | ||||
| User | 7 | 17.95 | 13 | 34.21 |
| Non-user | 32 | 82.05 | 25 | 65.79 |
| Presence of chronic disease | ||||
| Yes | 9 | 23.08 | 9 | 23.68 |
| No | 30 | 76.92 | 29 | 76.32 |
| Regular medication | ||||
| Yes | 9 | 23.08 | 12 | 31.58 |
| No | 30 | 76.92 | 26 | 68.42 |
| Constipation | ||||
| Never/rarely | 14 | 35.90 | 24 | 63.16 |
| Sometimes | 18 | 46.15 | 7 | 18.42 |
| Usually | 7 | 17.95 | 7 | 18.42 |
Table 2 shows the obstetric characteristics of participants in the training and control groups. The rate of women with 2 or more pregnancies in the training group was 52.63%, whereas it was 48.72% in the control group. 23.69% of the women in the training group and 17.94% of those in the control group had 1 or more abortions. 15.79% of the women in the training group, 25.64% of those in the control group had a vaginal delivery.
Table 2.
Obstetric characteristics of women: Nicosia, Cyprus, 2022.
| Control (n = 39) | Training (n = 38) | |||
|---|---|---|---|---|
| n | % | n | % | |
| Gravida | ||||
| 0 | 8 | 20.51 | 4 | 10.53 |
| 1 | 12 | 30.77 | 14 | 36.84 |
| 2 | 15 | 38.46 | 14 | 36.84 |
| 3 and more | 4 | 10.26 | 6 | 15.79 |
| Number of miscarriages | ||||
| 0 | 32 | 82.05 | 29 | 76.32 |
| 1 | 6 | 15.38 | 5 | 13.16 |
| 2 and more | 1 | 2.56 | 4 | 10.53 |
| Number of curettages | ||||
| 0 | 32 | 82.05 | 29 | 76.32 |
| 1 | 7 | 17.95 | 9 | 23.68 |
| Number of living children | ||||
| 0 | 9 | 23.08 | 4 | 10.53 |
| 1 | 13 | 33.33 | 18 | 47.37 |
| 2 and more | 17 | 43.59 | 16 | 42.11 |
| Mode of delivery in last pregnancy | ||||
| Vaginal delivery | 8 | 20.51 | 6 | 15.79 |
| Cesarean | 22 | 56.41 | 28 | 73.68 |
| Mode of delivery in any pregnancy | ||||
| Vaginal delivery | 10 | 25.64 | 6 | 15.79 |
| Cesarean | 20 | 51.28 | 28 | 73.68 |
| History of multiple pregnancies | ||||
| No | 38 | 97.44 | 38 | 100.00 |
| Twins | 1 | 2.56 | 0 | 0.00 |
| History of high–weight infant (4 kg and over) | ||||
| Yes | 36 | 92.31 | 33 | 86.84 |
| No | 3 | 7.69 | 5 | 13.16 |
| Familiarity with pelvic floor muscle exercises | ||||
| Yes | 23 | 58.97 | 22 | 57.89 |
| No | 16 | 41.03 | 16 | 42.11 |
| Regular pelvic floor muscle exercise | ||||
| Yes | 3 | 7.69 | 2 | 5.26 |
| No | 36 | 92.31 | 36 | 94.74 |
Table 3 shows the intergroup comparison of the FSFI total and subscale mean scores of the women in the training group measured at 3 different times before and after training. When the pretraining FSFI total and subscale mean scores of the women in the training and control groups were evaluated, no significant difference was found (P > .05). When the mean scores of the sexual desire subscale were evaluated in the training group, it was found that the mean scores of the women in the training group were similar in the pretraining period and the first and second months after training, and the mean score in the third month was significantly higher than that in the other months (P < .001).
Table 3.
Intragroup and intergroup comparison of FSFI total and subscale scores of the women in both groups at different times: Nicosia, Cyprus, 2022.
| Training group (n = 38) | Control group (n = 39) | z | P | ||
|---|---|---|---|---|---|
| Mean ± SD | Mean ± SD | ||||
| Sexual desire | Pretraining† | 2.99 ± 0.37 | 3.01 ± 0.55 | 1.482.000 | .285 |
| 1st month‡ | 3.97 ± 0.29 | 3.74 ± 0.49 | 1.067.500 | .072 | |
| 2nd month§ | 4.40 ± 0.37 | 3.48 ± 0.5 | 830.000 | <.001* | |
| 3rd month‖ | 5.62 ± 0.51 | 3.46 ± 0.45 | 789.000 | <.001* | |
| F | 150.210 | 21.750 | |||
| P | <.001* | .102 | |||
| Post hoc | 4 > 3,2,1 | ||||
| η2 | 0.323 | ||||
| Sexuel arousal | Pretraining† | 2.23 ± 0.19 | 2.41 ± 0.57 | 1.480.000 | .184 |
| 1st month‡ | 3.05 ± 0.47 | 3.13 ± 0.41 | 854.000 | .237 | |
| 2nd month§ | 3.22 ± 0.48 | 3.01 ± 0.36 | 44.000 | <.001* | |
| 3rd month‖ | 4.89 ± 0.35 | 3.12 ± 0.55 | 780.000 | <.001* | |
| F | 113.707 | 24.000 | |||
| P | <.001* | .346 | |||
| Post hoc | 4 > 3,2,1 | ||||
| η2 | 0.268 | ||||
| Lubrication | Pretraining† | 3.21 ± 0.51 | 3.16 ± 0.38 | 1.327.000 | <.421 |
| 1st month‡ | 3.75 ± 0.42 | 3.74 ± 0.41 | 721.500 | .838 | |
| 2nd month§ | 4.42 ± 0.31 | 3.69 ± 0.5 | 1.082.000 | <.001* | |
| 3rd month‖ | 4.63 ± 0.49 | 3.71 ± 0.63 | 860.500 | <.001* | |
| F | 70.479 | 24.644 | |||
| P | .001* | P.238 | |||
| Post hoc | 4 > 3,2,1 | ||||
| η2 | 0.492 | ||||
| Orgasm | Pretraining† | 2.93 ± 0.16 | 3.01 ± 0.54 | 1.482.000 | .725 |
| 1st month‡ | 3.42 ± 0.2 | 3.03 ± 0.57 | 987.000 | .008* | |
| 2nd month§ | 4.67 ± 0.42 | 3.12 ± 0.48 | 834.500 | <.001* | |
| 3rd month‖ | 5.06 ± 0.56 | 3.34 ± 0.27 | 102.500 | <.001* | |
| F | 109.727 | 26.929 | |||
| P | <.001* | .642 | |||
| Post hoc | 4 > 3,2,1 | ||||
| η2 | 0.342 | ||||
| Satisfaction | Pretraining† | 3.22 ± 0.55 | 3.24 ± 0.69 | 1.467.000 | .749 |
| 1st month‡ | 3.61 ± 0.37 | 3.18 ± 0.46 | 1.427.500 | .027* | |
| 2nd month§ | 4.16 ± 0.44 | 3.33 ± 0.72 | 265.000 | <.001* | |
| 3rd month‖ | 4.65 ± 0.22 | 3.31 ± 0.67 | 780.000 | <.001* | |
| F | 105.726 | 21.174 | |||
| P | <.001* | .538 | |||
| Post hoc | 4 > 2.1 3 > 1.2 | ||||
| η2 | 0.621 | ||||
| Pain/discomfort | Pretraining† | 3.14 ± 0.17 | 3.44 ± 1.31 | 1.052.000 | .478 |
| 1st month‡ | 4.97 ± 0.32 | 4.54 ± 0.84 | 507.500 | .129 | |
| 2nd month§ | 5.12 ± 0.26 | 4.25 ± 0.52 | 819.000 | <.001* | |
| 3rd month‖ | 5.96 ± 0.18 | 4.64 ± 0.79 | 907.000 | <.001* | |
| * | F | 109.461 | 8.010 | ||
| P | <.001* | .374 | |||
| Post hoc | 4 > 3,2,1 | ||||
| η2 | 0.171 | ||||
| FSFI total score | Pretraining† | 22.49 ± 0.81 | 22.52 ± 2.1 | 1.482.000 | <.842 |
| 1st month‡ | 22.92 ± 1.25 | 22.75 ± 1.31 | 1.197.000 | <.074 | |
| 2nd month§ | 28.40 ± 1.87 | 21.62 ± 1.51 | 49.000 | .017* | |
| 3rd month‖ | 30.81 ± 1.5 | 21.68 ± 1.09 | 780.000 | <.001* | |
| F | 114.000 | 31.677 | |||
| P | <.001* | .128 | |||
| Post hoc | 4 > 3,2,1 | ||||
| η2 | 0.542 |
F = Friedman test, FSFI = Female Sexual Function Index, SD = standard deviation – P < .05, z = Mann–Whitney U test, η2 = effect sizes.
Before training.
First month after the training.
Second month after the training.
Third month after the training.
P-values (P<.05) indicating statistically significant differences are highlighted in bold.
When the training and control groups were compared, no significant difference was found between the mean scores on the sexual desire subscale before training (P = .285) and the first month after training (P = .072). In the second and third months, a significant difference was observed between the training and control groups (P < .001).
When the sexual arousal subscale mean scores of the women in the training and control groups were compared, no significant difference was found in the mean scores detected before the training (P = .184) and in the first month after the training (P = .237). Intragroup evaluation of the women in the training group according to months revealed that the mean score of the sexual arousal subscale was significantly higher in the third month than in the pretraining period, first, and second months (F = 113.707, P < .001) and the effect size was large (η2 = 0.268).
When the lubrication subscale mean scores of the women in the training and control groups measured 3 times before and after the training were evaluated, it was found that the mean score of the lubrication subscale in the second and third months after the training was significantly higher (P < .001). When the training group was evaluated according to month, it was concluded that the mean scores of the lubrication subscale increased every month compared to the pretraining period, but a significant increase was found in the third month (F = 70.479, P < .001).
While there was no difference in the orgasm subscale mean scores of the women in the training and control groups before training (P = .725), there was a statistically significant difference at all measurement times after training (P < .001). Intragroup evaluations of women in the training group revealed that the mean scores in the third month after training were significantly higher.
It was determined that there was a statistically significant difference between the satisfaction subscale mean scores of the women in the training group measured before the training and at 3 different times after the training (F = 105.726, P < .001) and the effect size was large (η2 = 0.621). Accordingly, it was determined that the mean scores of the women in the training group were higher in the third month after the training than in the pretraining period, the first and second months after the training, in the second month after the training compared to the pretraining and the first month, and in the first month after the training compared to the pretraining period. While there was no difference in the orgasm subscale mean scores of the women in the training and control groups before training (P = .725), there was a statistically significant difference at all measurement times after training. A significant difference was observed in the first month after the training (P < .001).
When the pain subscale mean scores of the women in the training group were compared by month, it was found that the pain subscale mean scores increased every month after the training, but the pain subscale mean score in the third month increased significantly compared to the pretraining period and the first and second months after the training (F = 109.461, P < .001). When the training and control groups were evaluated, no significant difference was found in the first month before training; however, a significant difference was found in the second and third months. Mean pain subscale scores improved every month after training. However, a significant difference in the pain subscale score was detected in the second month after training (P < .001).
The FSFI total mean score of the women in the training group increased during the 3 months after the training compared to the pretraining period, but the difference was statistically significant in the FSFI total mean score in the third month after the training (F = 114.000, P < .001), and the effect size was large (η2 = 0.542). When women in the training and control groups were evaluated, no difference was found in the total scale scores before training and in the first month after training. The mean scores of the training group in the second (P < .017) and third months (P < .001) were significantly higher than those of the control group (Table 3).
4. Discussion
In this study, we evaluated the effect of regular pelvic floor muscle exercises on sexual function in women of reproductive age. The fact that there was no difference between the training and control groups in terms of sociodemographic and obstetric characteristics, educational status, and initial values of other measurement parameters showed that the groups had similar characteristics before the training.
In this study, it was found that while the sexual function status of the control group was similar before and after the education, the sexual function improvement in the training group increased significantly after the training. Women who received pelvic floor muscle exercise training had increased sexual desire, arousal, satisfaction, and orgasm, fewer lubrication needs, and less pain during sexual intercourse. Likewise, it was reported that both Kegel exercise and lubricating gel positively affected the sexual function of postmenopausal women; however, the long-term effectiveness of Kegel exercise was more positive.[30,31] The related studies have revealed a positive correlation between pelvic floor strength and sexual function scores. A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders.[25,32] In a study in which pelvic floor muscle exercise training was provided to women and their sexual function before and after the training was examined, it was reported that the sexual dysfunction scores of women decreased. These findings indicate that pelvic floor muscle exercises are a potential way to improve sexual function[12,33,34] In the present study, it was determined that more than half of the participants in the training and control groups had not heard of pelvic floor muscle exercises. Likewise, various studies have reported that women’s level of knowledge of pelvic floor muscle exercise is low[35–37]
The present study revealed that the sexual desire, sexual arousal, lubrication, orgasm, satisfaction, and pain/discomfort scores of the women in the training group increased after training compared to the pretraining period provided Kegel exercise training to postmenopausal women in their study and similarly reported higher sexual arousal and orgasm scores after training.[35] In a randomized controlled study evaluating the effect of postpartum pelvic floor muscle exercise on sexual function, regular exercise was reported to increase the orgasm score.[38] The present study revealed that while women’s sexual satisfaction started in the first month after training, sexual development related to orgasm started in the third month after training. This result showed that pelvic floor muscle exercise had a rapid effect on satisfaction. In their study, Braekken et al found that pelvic muscle exercise improved sexual function, libido, and orgasm and reduced coital pain in women with pelvic organ prolapse.[39]
In this study, the sexual desire score was found to be 2.99 ± 0.37 in women who did not receive pelvic floor exercise training, while in women who received training, it was found that sexual desire increased as they continued to perform pelvic floor muscle exercises and showed an increase over the months. By the third month, when a significant difference emerged, this score was found to be 5.62 ± 0.51. Similarly, in a randomized controlled study conducted in 2025, it was concluded that after 8 weeks of regular pelvic floor muscle exercises, the sexual desire score was 3.42 ± 0.4.[17] The scale scores of women who did not receive training in the sexual arousal subscale were found to be 2.23 ± 0.19, while their first assessment scores after training were found to be 2.41 ± 0.57, with no difference between the 2 scores. However, the difference emerged in the third month’s assessment, with a scale score of 4.89 ± 0.35. Similar results were obtained in other subscales. Only in the satisfaction subscale was a difference found from the second month onwards. The results of this study demonstrate the effects of regular pelvic floor muscle exercise. In one study, participants’ sexual arousal scores were found to be 2.77 ± 0.12 before Kegel exercise training and 3.15 ± 0.13 at the third-month assessment after regular pelvic exercises.[27] The present study found that the sexual health of women followed for 3 months improved every month after pelvic floor muscle exercise training. However, a significant change was observed in the 3rd month. This is because it took time to increase muscle tonus and coordination. Numerous studies have indicated that a response regarding the strengthening of the pelvic muscles cannot be obtained earlier than 4 weeks and muscle hypertrophy cannot occur before 6 to 8 weeks.[40,41] A study reviewing postgraduate theses reported that as the duration of pelvic floor muscle exercises increased, their effect on the pelvic muscles increased.[42]
5. Conclusion
In the present study, it was observed that the FSFI score of women who regularly performed pelvic floor muscle exercises after training increased, and the effect of the exercise on the FSFI mean score was observed in the 3rd-month measurements after they started to perform pelvic floor muscle exercises regularly. The results of the present study reveal the importance of pelvic floor muscle exercises for sexual health. Including these exercises in sexual health education programs can promote women’s sexual health. It is also important for women to perform pelvic floor muscle exercise. Exercise diaries may encourage women to exercise more regularly. In addition, the development of mobile applications to remind women to perform PFM exercises regularly may enable more women to exercise regularly.
6. Research limitations
The first limitation of the study is that women were given a program to follow the exercises, and their statements were used as the basis. The FSFI scale is a self-reported measure that may be subject to social desirability bias or recall bias. Therefore, the results are based on participants’ reports. Another limitation is that inter-partner harmony was not assessed to better evaluate the results related to sexual function. In addition, there are no data on whether women who give birth vaginally have assisted delivery using devices such as vacuum or forceps. Vacuum and forceps can damage the pelvic floor muscles. Furthermore, participants were invited via social media programs, and data were collected through an online form. This method made it possible to reach women with basic and above digital literacy.
Acknowledgments
We would like to thank the volunteers for their participation and contribution to this study.
Author contributions
Conceptualization: Serap Tekbaş.
Data curation: Serap Tekbaş.
Methodology: Serap Tekbaş.
Resources: Serap Tekbaş.
Software: Serap Tekbaş.
Supervision: Serap Tekbaş.
Validation: Serap Tekbaş.
Visualization: Serap Tekbaş.
Writing – original draft: Serap Tekbaş.
Writing – review & editing: Serap Tekbaş.
Abbreviations:
- ANOVA
- analysis of variance
- FSFI
- Female Sexual Function Index
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Tekbaş S. The effect of pelvic floor muscle exercise on sexual function in women of reproductive age: A randomized controlled trial. Medicine 2025;104:37(e44324).
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