The effect of pelvic floor muscle training on pelvic floor function and sexuality postpartum. A randomized study including 300 primiparous

Effect of postpartum pessary use on pelvic floor function: a prospective multicenter study

PURPOSE

This study evaluates the restitution of pelvic floor function in postpartum women using the Restifem® pessary in a preventive and therapeutic approach.

METHODS

In this multicentre study all postpartum women independently of their parity, mode of delivery and existing pelvic floor symptoms were offered to use the Restifem® pessary from 6 weeks postpartum for 3 to 6 months. They completed the validated German pelvic floor questionnaire (GPFQpp) via online survey at 6 weeks, 6 months and 12 months postpartum and were divided, by their own choice, into users and non-users of the pessary.

RESULTS

Initially 857 women were enrolled. After 6 weeks 137 pessary users and 133 non-users, after 12 months 53 pessary users and 45 non-users submitted a completed questionnaire. Pessary users had significantly higher (worse) scores in all domains of the GPFQpp at 6 weeks postpartum. At 12 months postpartum pessary users still had a significantly higher bladder score, compared to non-users. There was a greater improvement in the bladder score (p = 0.005) and the pelvic organ prolapse score (p < 0.001) from 6 weeks to 12 months postpartum, among pessary users compared to non-users.

CONCLUSION

Pessary users had a significantly greater improvement in pelvic floor function from 6 weeks to 12 months postpartum, compared to non-users. This effect might be in part due to wearing the pessary but also due to greater scope for recovery, given the higher level of pelvic floor dysfunction in the pessary user group.

TRIAL REGISTRATION

The trial was registered in the German Clinical Trials Register (DRKS00024733) on 19 of April 2021.

Sexual functioning is not, but psychological burden is predictive for receiving help in pelvic physical therapy practice: A cross-sectional study

Background

Pelvic floor complaints are common among women and often accompanied by sexual dysfunction and psychological burden. They are also associated with pregnancy and childbirth. However, not all women with these complaints receive help in pelvic physical therapy practice. This study explored if pregnancy, parity, pelvic floor complaints, sexual functioning, and psychological burden are predictive of receiving help in pelvic physical therapy practice.

Methods

In a cross-sectional exploratory design, women completed an online survey about pelvic floor complaints, sexual function, and psychological burden. Binary logistic analysis was used to analyze the predictive value of the above-mentioned factors.

Results

Data from 542 participants were analyzed. Pregnancy and parity, PFC severity, psychological burden, and the interaction between pelvic floor complaints and psychological burden were significant predictors of receiving help. Against expectations, sexual functioning was not predictive of receiving help.

Conclusions

Women's psychological burden is an important factor in determining if or when women receive help in PPT practice. More research is needed to unravel the role of sexual functioning in the context of pelvic floor complaints and women's psychological burden. More insight into this area of expertise could possibly improve and enhance pelvic health care for women with pelvic floor complaints.

Effect of Pelvic Floor Muscle Training With Smartphone Reminders on Women in the Postpartum Period: A Randomized Controlled Trial

IMPORTANCE

Standard postpartum pelvic floor muscle training (PFMT) can effectively reduce the incidence of pelvic floor dysfunction diseases.

OBJECTIVE

This study aimed to evaluate the adherence of PFMT with smartphone application reminders on women in the postpartum period.

STUDY DESIGN

We conducted a randomized controlled trial. This single-center randomized (1:1) controlled study included primiparous women admitted to Tongji Hospital between March 2022 and June 2022 (ChiCTR2200059157). Every puerpera was given pelvic floor muscle (PFM) assessment and PFMT guidance at 6 weeks after delivery. After randomization, women in the intervention group received daily training reminders from the smartphone application WeChat. Adherence to PFMT, a symptom of stress urinary incontinence, and PFM characteristics were measured 3 months later.

RESULTS

A total of 148 participants were included in the final analysis (76 in the intervention group and 72 in the control group). The adherence rate of daily PFMT was higher in the intervention group than in the control group (53.9% vs 20.8%, P = 0.00) at 3-month follow-up. In addition, participants in the intervention group showed higher peak surface electromyography of PFMs (39.8 ± 6.2 vs 37.5 ± 5.9 μV, P = 0.03) and longer PFM endurance (8.1 ± 2.0 vs 7.3 ± 2.0 seconds, P = 0.01) than in the control group, whereas there was no difference between the 2 groups in International Consultation on Incontinence Questionnaire-Short Form ( P = 0.60) and the Patient Global Impression of Improvement scores ( P = 1.00).

CONCLUSIONS

Smartphone application-based PFMT could increase adherence and improves electromyography of PFMs in the short term but did not affect stress urinary incontinence symptoms in women in the postpartum period.

Predictive value of abdominal wall scar score for pelvic floor function rehabilitation, vaginal microecology and complications after cesarean section

Objective

To explore the predictive value of the abdominal wall scar score for pelvic floor function rehabilitation, vaginal microecology and complications after cesarean section.

Methods

A total of 120 pregnant women who underwent cesarean section in our hospital from January to December 2022 were selected. The patients were divided into observation group (score ≥ 60, n = 52) and control group (score < 60, n = 68) according to the preoperative score of abdominal wall scar and whether the score exceeded 60. The pelvic floor function rehabilitation, vaginal microecology and complications were compared between the two groups, and the score of abdominal wall scar was evaluated by receiver operating characteristic (ROC) curve. The predictive value of pelvic floor function rehabilitation, vaginal microecology and complications after cesarean section was evaluated.

Results

There were significant differences between the two groups in postpartum class I and class II muscle fiber strength and pelvic floor muscle potential (P < 0.05). ROC curve showed that the AUC of abdominal scar score in predicting pelvic floor function rehabilitation was 0.806 (95% CI [0.684-0.927]), the specificity was 80.17%, and the sensitivity was 79.76%. There was significant difference in the abnormal rate of leukocte estrase (LE) and Acetylaminoglucosidase (NAG) between the two groups (P < 0.05). ROC curve showed that the AUC of abdominal scar score in predicting vaginal microecology was 0.871 (95% CI [0.776-0.966]), the specificity was 85.09%, and the sensitivity was 82.36%. There was significant difference in the incidence of postpartum complications between the two groups (P < 0.05). ROC curve showed that the AUC of abdominal scar score in predicting complications was 0.844 (95% CI [0.735-0.953]), the specificity was 82.27%, and the sensitivity was 81.15%.

Conclusion

The abdominal scar score has a certain effect on predicting the recovery of pelvic floor function, vaginal microecology and complications after cesarean section. Therefore, it can help the medical staff to adjust the treatment measures in time, which can be used as a means of preoperative auxiliary examination.

Investigation of the effects of pelvic floor training on pain, sexual dysfunction, and quality of life in female patients with primary Sjögren syndrome

AIM

To investigate the effects of pelvic floor training on pain, sexual dysfunction and quality of life in female patients with primary Sjögren syndrome (pSS) and determine whether pelvic floor training was superior to an education program.

METHODS

Forty-six pSS patients (all women) with an average age of 47.78 ± 9.18 years were included in the study. Patients were divided into two groups as a pelvic floor training group and control group for 8 weeks. Visual Analog Scale (VAS), Pelvic Pain Impact Questionnaire (PPIQ), Female Sexual Function Scale (FSFI), Health Assessment Questionnaire (HAQ), Pelvic Floor Disability Index-20 (PFDI-20), and Pelvic Floor Impact Questionnaire (PFIQ-7) were used to evaluate the outcomes. All evaluations were performed at baseline and at the end of the 8th week.

RESULTS

When the groups were compared before training, there was no significant difference (p > .05). In post-training comparisons, there were significant differences in VAS, PPIQ, FSFI, PFIQ-7, and PFDI-20 in the pelvic floor training group (p values between .02 and .00), and in FSFI-lubrication, PFIQ-7, and PFDI-20 (p values between .00 and .03) in the control group. According to Δ values, the pelvic floor training group was found to be superior in terms of FSFI orgasm, pain, and lubrication scores (p = .00) and all sub-parameters of PFDI-20 (p = .00).

CONCLUSION

Pelvic floor training has a positive effect on the sexual dysfunction and discomfort caused by pelvic symptoms in patients with pSS. Pelvic floor training should be included in rehabilitation programs to improve sexual function and pelvic floor dysfunctions for patients with pSS.

The complexity of female orgasm and ejaculation

The anatomy and physiology of the female orgasm are often neglected. The female orgasm is a normal psychophysiological function to all women, and some even can achieve ejaculation as part of the normal physiological response at the height of sexual arousal. The complexity of female sexuality requires a deep understanding of genital anatomy. The clitoris is the principal organ for female pleasure. The vaginal stimulation of the anterior vaginal wall led women to orgasm due to the stimulation of the clitourethrovaginal complex and not due to stimulation of a particular organ called the G spot in the anterior distal vaginal wall. Female ejaculation follows orgasm. It consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate. Squirting can be differentiated from female ejaculation because it is the orgasmic transurethral expulsion of a substantial amount of diluted urine during sexual activity, and it is not considered pathological. The female orgasm is influenced by many aspects such as communication, emotional intimacy, long-standing relationship, adequate body image and self-esteem, proper touching and knowledge of the female body, regular masturbation, male sexual performance, male and female fertility, chronic pain, and capacity to engage in new sexual acts. Stronger orgasms could be achieved when clitoral stimulation, anterior vaginal wall stimulation, and oral sex is involved in the same sexual act.

Evaluating compliance and applicability of postpartum pessary use for preventing and treating pelvic floor dysfunction: a prospective multicenter study

PURPOSE

Pelvic floor disorders are common and associated with pregnancy and childbirth. For restitution of pelvic floor connective tissue and thereby therapy of postpartum pelvic organ prolapse and stress urinary incontinence, the Restifem® pessary is approved. It supports the anterior vaginal wall behind the symphysis, the lateral sulci and the sacro-uterine ligaments and stabilises the connective tissue. We evaluated the compliance and applicability of Restifem® use in women postpartum in a preventive and therapeutic approach.

METHODS

Restifem® pessary was handed out to 857 women. Six weeks after birth, they started the pessary use. After 8 weeks, 3 and 6 months postpartum, women received a questionnaire via online survey for evaluation of pessary applicability and efficacy.

RESULTS

After 8 weeks, 209 women answered the questionnaire. 119 women used the pessary. Common problems were discomfort, pain and the pessary use was to circuitous. Vaginal infections were rare. After 3 months, 85 women and after 6 months, 38 women still used the pessary. 3 months postpartum, 94% of women with POP, 72% of women with UI and 66% of women with OAB stated to have an improvement of their symptoms using the pessary. 88% women without any disorder felt an improvement of stability.

CONCLUSIONS

Use of the Restifem® pessary in the postpartum period is feasible and accompanied with less complications. It reduces POP and UI and leads to an increased sense of stability. So, Restifem® pessary can be offered to women postpartum to improve pelvic floor dysfunction.

Sexual Function in Women at 6 and 12 Months After Obstetric Anal Sphincter Injury: Is Pelvic Floor Physical Therapy Associated With Improved Outcomes?

IMPORTANCE

Women with obstetric anal sphincter injury (OASI) are at increased risk of postpartum sexual dysfunction. Risk persists beyond 3 years after perineal trauma in up to half of patients with OASI.

OBJECTIVES

The aims of this study were to determine if postpartum pelvic floor physical therapy (PFPT) is associated with improved sexual function after vaginal delivery with OASI and to describe sexual function in patients with OASI at 6 and 12 months postpartum.

STUDY DESIGN

This is a retrospective cohort study of patients with OASI. Women were grouped according to PFPT attendance. The Postpartum Pelvic Floor and Birth Questionnaire (PPFBQ), which compares current sexual function to baseline prepregnancy sexual function, and the Female Sexual Function Index (FSFI) were administered at 6 and 12 months, respectively, to evaluate postpartum sexual function.

RESULTS

Two hundred women were included. Sixty-four (32%) women attended PFPT; 136 (68%) did not attend PFPT. Patients reported worse-than-baseline sexual function at 6 months postpartum in the PPFBQ sexual activity domain, but the PFPT group had lower median score than the non-PFPT group (2.3 [2.0, 2.8] vs 2.7 [2.1, 3.1], P = 0.034), with scores <3.0 indicating worse-than-baseline functioning. The FSFI composite scores were similar between groups and showed 80.7% of the patients with OASI meeting the criteria for female sexual dysfunction at 12 months postpartum. Attendance of PFPT was not significantly associated with composite FSFI scores and most domains of PPFBQ.

CONCLUSIONS

Attendance of PFPT did not significantly impact overall sexual function in OASI patients at 6 and 12 months postpartum. Sexual function is complex and may be more effectively addressed in the postpartum period using a multidimensional approach.