Effectiveness of Kegel exercise and lubricant gel for improving sexual function in menopausal women: A randomized trial

Exercise and Sexuality in Women With Menopausal Symptoms: A Systematic Review and Meta-Analyses of Randomized Controlled Trials

AIMS

This systematic review and meta-analysis study aim to assess the impact of different exercise modalities interventions in postmenopausal women on sexuality and the severity of menopausal symptoms.

METHODS

The preparation of this systematic review and meta-analysis rigorously adhered to the PRISMA 2020. This systematic review of the literature was conducted between May and June 2023, utilizing four electronic databases: PubMed, Cochrane Library, Web of Science and ULAKBİM. Articles were screened using MeSH-based keywords. Randomized Controlled Trials conducted within the last decade were included in the screening. Data analysis was performed using the Review Manager computer program.

RESULTS

The analysis encompassed eight studies involving 1127 postmenopausal women. According to the results of the pooled random-effects model, applied to women after 12 weeks of exercise, the data were significant, indicating a positive impact on sexuality (MD: 0.86, 95% CI: 0.72 to 1.01, Z = 11.47, p < 0.00001). Concerning the psychological symptoms of menopause, the data were also found to be significant, with improvements observed after 12 weeks of exercise in women (MD: 0.25, 95% CI: 0.02 to 0.49, Z = 2.15, p = 0.03).

CONCLUSION

This study provides evidence that a 12-week exercise regimen administered during the postmenopausal period positively influences postmenopausal women's sexuality and ameliorates psychological menopausal symptoms. However, it does not appear to have an effect on vasomotor menopausal symptoms.

PROSPERO NUMBER

CRD42023427991.

Sexual health promotion interventions in Iranian postmenopausal women: A systematic review of randomized controlled trials

This study aimed to systematically review published articles on sexual health promotion interventions in postmenopausal Iranian women. Five databases including PubMed, ProQuest, Web of Science, Science Direct, and Google Scholar, as well as three Iranian databases, including SID, IranDoc, and Magiran, were searched without a time limit for sexual health promotion interventions in Iranian postmenopausal women. The risk of bias was assessed using the Jadad scale. In total, 48 articles met our inclusion criteria and provided data for this review. The measured outcomes were different aspects of sexual function. Outcomes were measured using a specific questionnaire related to sexual function and its areas. The results obtained from the tools used have led to the classification of the results based on the type of interventions used to improve the sexual health of postmenopausal women. The main groups were drug interventions (chemical and herbal) and non-drug interventions (psychological and educational). Surveys showed that most interventions performed on sexual health in Iranian postmenopausal women were medicinal (herbal) interventions. Numerous studies obtained a good quality score. The results of this study can be used to improve the sexual health of postmenopausal women.

Effectiveness of Integrated Mindfulness-Based Fitness Training Program in Ameliorating Physical Symptoms and Survivor Concerns in Patients With Breast Cancer: A Randomized Clinical Trial

BACKGROUND

Patients with breast cancer typically experience both mental and physical distress after aggressive treatments. Some studies have explored the use of integrated interventions, such as mindfulness-based or exercise-based approaches, to reduce these symptoms. However, the results of these studies have been conflicting.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of an integrated mindfulness-based fitness training (MBFT) program in addressing overactive bladder, fear of cancer recurrence, and female sexual function in patients with breast cancer.

METHODS

Fifty patients with breast cancer were either assigned to an 8-week MBFT group or a waitlist control group. The postintervention and preintervention scores were compared using descriptive analysis of the data set, as well as paired and independent t tests.

RESULTS

There was no significant improvement in overactive bladder symptoms. Significant differences were observed in survivor concerns for items related to future diagnostic tests (t = 2.667, P = .024; 95% confidence interval [CI], 0.120-1.335), another type of cancer (t = 2.667, P = .024; 95% CI, 0.120-1.335), cancer coming back (t = 4.183, P = .002; 95% CI, 0.297-0.975), dying (t = 2.609, P = .026; 95% CI, 0.093-1.180), and my health (t = 2.887, P = .016; 95% CI, 0.104-0.805). A significant difference was found in the item measuring overall sexual life satisfaction (t = -3.162, P = .013) and sexual desire (MBFT vs waitlist control group, 2.00 vs 1.18; P = .023).

CONCLUSION

Mindfulness-based fitness training interventions were effective in enhancing the well-being of patients with breast cancer by reducing fear of recurrence and enhancing sexual function. These findings support the use of MBFT as complementary therapy.

IMPLICATIONS FOR PRACTICE

Healthcare providers should carefully assess the individual needs and preferences of each patient and tailor interventions accordingly. In addition, integrating multiple approaches may be more effective in reducing distress.

Effects of Kegel exercise combined with rational emotive behavior therapy on pelvic floor muscle function and sexual life quality in patients with total hysterectomy: A retrospective study

To explore the clinical effects of Kegel exercise combined with rational emotive behavior therapy (REBT) on the pelvic floor muscle function, medical coping style, and sexual life quality after total hysterectomy. This was a retrospective cohort study. A total of 91 patients were collected in this study: 39 patients in Kegel group (received Kegel exercise alone) and 52 patients in combination group (received Kegel exercise combined with REBT). Propensity score matching (PSM) with 1:1 ratio was conducted to avoid the selection bias. The female sexual function index (FSFI) was used to evaluate and compare sexual life quality. After PSM, 35 patients were in each group (combination vs Kegel). The normal rate of pelvic floor muscle in combination group was significantly higher than that in Kegel group (88.57% vs 54.29%, P = .041). After surgery, the score of confrontation was higher, while the scores of avoidance and acceptance-resignation were lower in combination group compared with those in Kegel group. The postoperative total FSFI score and the scores of all dimensions were higher in combination group than those in Kegel group. In patients with total hysterectomy, Kegel exercise combined with REBT can significantly improve pelvic floor muscle function, medical coping style and sexual life quality. Therefore, it is worthy of clinical application.

Effect of folic acid on the sexual function of postmenopausal women: a triple-blind randomized controlled trial

BACKGROUND

There are reports of sexual dysfunction in postmenopausal women, and several treatment recommendations are available.

AIM

To investigate the effect of folic acid on postmenopausal women's sexual function.

METHODS

This triple-blind randomized controlled trial was conducted in Tehran, Iran, in 2020. A sample of 100 postmenopausal women was recruited from comprehensive health centers affiliated with the Shahid Beheshti University of Medical Sciences. Eligible women were randomly assigned to receive folic acid (5 mg) or placebo on an empty stomach every day for 8 weeks. Women were assessed at 3 time points: baseline and 4 and 8 weeks after the intervention.

OUTCOME

Sexual function was the main outcome, as measured by the Female Sexual Function Index.

RESULTS

The mean ± SD age of participants in the folic acid and placebo groups was 53.2 ± 3.84 and 54.4 ± 4.05 years, respectively (P = .609). The results obtained from mixed effects analysis of variance revealed a statistically significant difference between baseline and posttreatment scores and the interaction between time and group for desire, orgasm, satisfaction, arousal, pain, and total sexual function score, with the folic acid group improving more than control group. Lubrication was the only domain that showed no significant difference for the interaction between time and group.

CLINICAL IMPLICATIONS

Folic acid may beneficially affect sexual function in postmenopausal women.

STRENGTHS AND LIMITATIONS

Strengths include the novelty of the subject, the triple-blind design, the block randomization, the administration of a standard scale for sexual function (Female Sexual Function Index), and the affordability and availability of folic acid. This study was conducted with a small sample size and short follow-up time; therefore, interpretation of the results requires great caution.

CONCLUSION

The findings suggest that folic acid possibly improves sexual function in postmenopausal women. Larger studies are needed to confirm the findings.

TRIAL REGISTRATION

IRCT20150128020854N8; August 2, 2020. Iranian Registry of Clinical Trials; https://en.irct.ir/user/trial/48920/view.

The Effect of Body Practices and Physical Exercise on Sexual Function of Menopausal Women. A Systematic Review with Meta-Analysis

Objective

To review randomized clinical trials on Body Practices (BP) and Physical Exercise (PE) in menopausal women and describe their effect on sexual function.

Methods

Searches carried out electronically in five databases, with a temporal criterion of 10 years of publication, from August to September 2022. Methodological quality and risk of bias were assessed using the Cochrane collaboration scale and PEDro (Physiotherapy Evidence Database Physiotherapy Evidence Database) scale score.

Results

The majority of the studies presented a "'low" or "'uncertain" risk of bias. The instruments for assessing sexual function were heterogeneous. Interventions included mindfulness, relaxation hypnosis, Kegel exercises, yoga, and aerobic exercise, and generally lasted 12 weeks. Seven studies were included, of which six made up the meta-analysis, showing high heterogeneity (I2 = 94.2%; p < 0.0001). The analysis of subgroups with BP showed high heterogeneity (I2 = 94.2%; p < 0.01); interventions with PE presented more favorable results (I2 = 0%; 0; p = 0.90); the sexual function instruments showed high heterogeneity (I2 = 90%; p < 0.01); and instruments of quality of life and menopausal symptoms with domains of sexual function presented favorable results for BP and PE (I2 = 0%; p = 0.63). The funnel chart presents the studies in a dispersed manner, which implies publication bias.

Conclusions

Interventions with PE proved to be more efficient compared to BP, however, there are a low number of studies with PE, and those found are limited to aerobic training, without sufficient data on intensity, volume, and frequency. Further studies with PE are needed for the treatment of sexual function symptoms in order to more comprehensively describe their effect.

Pelvic floor muscle rehabilitation for genitourinary syndrome of menopause: why, how and when?

Genitourinary syndrome of menopause (GSM) is caused by chronic deprivation of estrogen and other sex steroids during the postmenopausal period, which leads to changes in the vulvovaginal tissues. These changes cause bothersome symptoms, such as vaginal dryness, pruritus, dyspareunia, increased daytime urinary frequency, urgency and urinary incontinence, which have considerable negative effects on women's quality of life and sexual function. Recent studies have investigated a novel treatment approach for GSM. Pelvic floor muscle (PFM) rehabilitation, a low-cost conservative management with no side-effects, has been studied alone or in combination with other treatment modalities to reduce the signs and symptoms of GSM. The aim of this article is to discuss why PFM rehabilitation could be useful for women with GSM, how it may help improve signs and symptoms of GSM and when this treatment should be recommended.

A situation analysis on postmenopausal women's self-care needs and priorities in Tehran: a population-based study

BACKGROUND

Women need special care during and after menopause. Due to the emphasis of the World Health Organization on promoting self-care in postmenopausal women, this study aims to analyze the situation and prioritize the self-care needs of postmenopausal women in the Tehran-Iran.

METHODS

This was a descriptive-analytical study on 486 postmenopausal women aged 46-85 years living in Tehran in 2021. The Subjects were recruited using a multi-stage sampling method. Data were collected using a socio-demographic and a valid and reliable questionnaire to assess postmenopausal women's self-care status with four domains including physical health, psychosocial health, reproductive-sexual health, and screening tests. The data were analyzed by SPSS-24.

RESULTS

The mean age of the participants was 62.58 ± 7.75 years. The mean score of self-care was 44.63 ± 21.64% in the postmenopausal women. The lowest score and highest scores were related to psychosocial health (25.12 ± 28.21%) and periodic tests (50.62 ± 24.40%) respectively. There were significant positive correlations between self-care with women's education level (r = 0.277; p < 0.001), husband's education level (r = 0.258; p < 0.001), as well as monthly income (r = 0.153; p = 0.001). There was a negative correlation between self-care with the number of children (r = - 0.215; p < 0.001). The level of self-care was higher in employed women (p = 0.001) and also, in women whose husbands were employed (p = 0.012). Multiple linear regression test showed the level of education of the husband (B = 2.72, p = 0.038) and the family size (B = -1.54, p = 0.023) are predictors of the self-care of postmenopausal women.

CONCLUSION

The findings showed more than 55% of challenges in the self-care behaviors of postmenopausal women in Tehran. The most and least challenging self-care behaviors were related to psychosocial health and performing periodic tests. The priorities were in psychosocial health and reproductive-sexual health dimensions. Self-care promotion is necessary, especially in postmenopausal women, who need special care due to various physical, psychological, and social changes.