Introduction and hypothesis
We evaluated the associations between pelvic floor muscle strength and tone with sexual activity and sexual function in women with pelvic floor disorders.
This was a secondary analysis of a multicenter study of women with pelvic floor disorders from the USA and UK performed to validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Participants were surveyed about whether they were sexually active and completed the PISQ-IR and the Female Sexual Function Index (FSFI) questionnaires to assess sexual function. Physical examinations included assessment of pelvic floor strength by the Oxford Grading Scale, and assessment of pelvic floor tone as per ICS guidelines.
The cohort of 585 women was middle-aged (mean age 54.9 ± 12.1) with 395 (67.5 %) reporting sexual activity. Women with a strong pelvic floor (n = 275) were more likely to report sexual activity than women with weak strength (n = 280; 75.3 vs 61.8 %, p < 0.001), but normal or hypoactive pelvic floor tone was not associated with sexual activity (68.8 vs 60.2 %, normal vs hypoactive, p = 0.08). After multivariable analysis, a strong pelvic floor remained predictive of sexual activity (OR 1.89, CI 1.18–3.03, p < 0.01). Among sexually active women (n = 370), a strong pelvic floor was associated with higher scores on the PISQ-IR domain of condition impact (parameter estimate 0.20± 0.09, p = 0.04), and the FSFI orgasm domain (PE 0.51 ± 0.17, p = 0.004).
A strong pelvic floor is associated with higher rates of sexual activity as well as higher sexual function scores on the condition impact domain of the PISQ-IR and the orgasm domain of the FSFI.
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Kegel AH (1952) Sexual functions of the pubococcygeus muscle. West J Surg Obstet Gynecol 60(10):521–524
Graber B, Kline-Graber G (1979) Female orgasm: role of pubococcygeus muscle. J Clin Psychiatry 40(8):348–351
Shafik A (2000) The role of the levator ani muscle in evacuation, sexual performance and pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct 11(6):361–376
Shafik A (1995) Vagino-levator reflex: description of a reflex and its role in sexual performance. Eur J Obstet Gynecol Reprod Biol 60(2):161–164
Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21(1):5–26
Lowenstein L, Gruenwald I, Gartman I, Vardi Y (2010) Can stronger pelvic muscle floor improve sexual function? Int Urogynecol J 21(5):553–556
Bø K, Talseth T, Vinsnes A (2000) Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstet Gynecol Scand 79(7):598–603
Lara LA, Montenegro ML, Franco MM, Abreu DC, Rosa e Silva AC, Ferreira CH (2012) Is the sexual satisfaction of postmenopausal women enhanced by physical exercise and pelvic floor muscle training? J Sex Med 9(1):218–223
Rogers RG, Rockwood TH, Constantine ML et al (2013) A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Int Urogynecol J 24(7):1091–1103
Rockwood TH, Constantine ML, Adegoke O et al (2013) The PISQ-IR: considerations in scale scoring and development. Int Urogynecol J 24(7):1105–1122
Bump RC, Mattiasson A, Bø K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17
Laycock J (1995) Pelvic floor dysfunction. University of Bradford, UK
Sandvik H, Hunskaar S, Seim A, Hermstad R, Vanvik A, Bratt H (1993) Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health 47(6):497–499
Lukacz ES, Lawrence JM, Buckwalter JG, Burchette RJ, Nager CW, Luber KM (2005) Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey. Int Urogynecol J Pelvic Floor Dysfunct 16(4):272–284
Barber MD, Kuchibhatla MN, Pieper CF, Bump RC (2001) Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 185(6):1388–1395
Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193(1):103–113
Barber MD, Walters MD, Cundiff GW; PESSRI Trial Group (2006) Responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women undergoing vaginal surgery and pessary treatment for pelvic organ prolapse. Am J Obstet Gynecol 194(5):1492–1498
Meston CM (2003) Validation of the Female Sexual Function Index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder. J Sex Marital Ther 29(1):39–46
Rosen R, Brown C, Heiman J et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208
Martinez CS, Ferreira FV, Castro AA, Gomide LB (2014) Women with greater pelvic floor muscle strength have better sexual function. Acta Obstet Gynecol Scand 93(5):497–502
Messelink B, Benson T, Berghmans B et al (2005) Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn 24(4):374–380
Wehbe SA, Whitmore K, Kellogg-Spadt S (2010) Urogenital complaints and female sexual dysfunction. I. J Sex Med 7(5):1704–1713, quiz 1703, 1714–1715
Rogers RG, Kammerer-Doak D, Villarreal A, Coates K, Qualls C (2001) A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse. Am J Obstet Gynecol 184(4):552–558
We would like to acknowledge Dr Clifford Qualls for his help with the statistical analysis of these data.
Conflicts of interest
G. Kanter: none; R.G. Rogers: DSMB Chair for the TRANSFORM trial sponsored by American Medical Systems, UptoDate royalties; R.N. Pauls: Scientific Advisory Board, Viveve Inc; D. Kammerer-Doak: Committee Chair for the IUGA R&D Committee; R. Thakar: occasional speaker for Astellas, Secretary for IUGA, Honorarium from McGraw-Hill.
No funding was obtained to support this secondary analysis.
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Kanter, G., Rogers, R.G., Pauls, R.N. et al. A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders. Int Urogynecol J 26, 991–996 (2015). https://doi.org/10.1007/s00192-014-2583-7
- Pelvic floor disorders
- Pelvic floor strength
- Sexual activity