To evaluate pelvic floor muscle training (PFMT) on sexual function and pelvic floor muscle (PFM) strength in postpartum women.

This is a systematic review with meta-analysis of randomized clinical trials, registered in PROSPERO (ID: CRD42023444883). The search was carried out in the Cochrane Library, PubMed, SciELO, PEDro and BVS databases, with the following descriptors and boolean operators: (pelvic floor muscle training OR pelvic floor muscle exercise OR kegel exercise AND sexual function AND postpartum OR puerperium). Data collection was carried out between July 2023 and March 2024. Randomized controlled clinical trials that addressed the effect of PFMT on the sexual function of postpartum women were included, without publication date restrictions. Duplicate articles, of other designs, that addressed different intervention methods and that were not available in full were excluded. The PEDro Scale was used to analyze methodological quality, and the meta-analysis was carried out using the RevMan 5 software.

Six studies with a total of 721 primiparous women in the postpartum period were included for analysis. The average score on the PEDRO scale was 5.8/10, with 3 studies considered reasonable (4-5) and 3 good (6-8). The start of interventions varied from shortly after birth to 8 months postpartum. In 2 studies, the intervention group received supervised training at least once a week for 6 weeks and 4 months and, in 1 study, once a month for 3 months. In the other 3 there was only a meeting on how to carry out the training. In all studies, women were instructed to perform the PFMT at home, with 4 carrying out follow-up via telephone, once a month. Only 1 study described training with variations in postures (sitting, standing and lying down) and the rest did not mention the ways of carrying it out. In all PFMT groups, it was observed that it was advised to be performed daily, in isolation, twice a day, with repetitions ranging from 16 to 150 contractions, with an interval of approximately 3 weeks to 7 months. As for the control group, 3 studies did not carry out any type of intervention, 2 received only information about PFMT and usual care, 1 did not specify what the group did, 1 performed postnatal gymnastics exercises and 1 performed conventional home treatment. Regarding the primary outcome, 4 of the articles showed that PFMT significantly improves sexual function, mainly regarding desire. In relation to other domains, 4 studies found positive effects on orgasm, arousal and lubrication, with 2 of the studies reporting an improvement in sexual satisfaction and 1 showing an improvement in sexual self-efficacy. Regarding PFM muscle strength, all studies have shown that PFMT is effective in increasing the degree of strength.
Figure 1 represents the meta-analysis between PFMT versus no type of exercise, while Figure 2 represents an analysis of a single study of audio-guided training with an app and conventional training at home. A third analysis of a single study was also carried out, on PFMT versus no exercise, but Risk Ratio was used, not difference in means, which was not favorable to PFMT.

PFMT proved to be effective in improving sexual function in primiparous women, in all its domains. A 2024 study (1) with healthy women and women with sexual dysfunction observed a benefit from this intervention on sexual function, and meta-analyses confirmed its positive effect on arousal, orgasm, satisfaction, pain and the total score of the Female Sexual Function Index, similar to ours. findings. Regarding sexual self-efficacy, the results of this review converge on the influence of PFMT on its improvement, as seen by a quasi-experimental study carried out in 2019 with 32 primiparous women (2). Our study observed that PFMT also contributed to a significant increase in PFM strength, which may be related to improved sexual function, mainly in the areas of orgasm, desire, arousal and lubrication, as demonstrated in another study (3). It is necessary to highlight that the results must be interpreted cautiously, due to the low number of studies included for review, in addition to presenting divergences in methodology and interpretation of results.

PFMT can promote positive effects on sexual function and PFM strength in primiparous women, especially when compared to no intervention. However, more studies of high methodological quality need to be conducted in order to guide professional practice regarding the need for early and effective interventions for sexual function in women during the postpartum period.

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 Jan 6:S0002-9378(24)00006-1. doi: 10.1016/j.ajog.2024.01.001.
Lolowang NL, Afiyanti Y, Ungsianik T. Kegel’s exercise to improve sexual self-efficacy in primiparous women. Enfermería Clínica. 2019 Sep 1;29:535–40.
Sacomori C, Virtuoso JF, Kruger AP, Cardoso FL. Pelvic floor muscle strength and sexual function in women. Fisioterapia em Movimento. 2015 Dec;28(4):657–65.

Continence 12S (2024) 101622
DOI: 10.1016/j.cont.2024.101622