The Relationship Between Pelvic Floor Function and Sexual Function in Perimenopausal Women

Exploring the Intersection of Depression, Anxiety, and Sexual Health in Perimenopausal Women

Purpose

The perimenopausal period is marked by hormonal fluctuations that trigger a complex interplay between estrogen levels and neurotransmitters' function, contributing to increased susceptibility to depression and anxiety in women. Concurrently, hormonal changes, coupled with alterations in vaginal tissue, lead to sexual dysfunction during this transitional phase. This study aimed at evaluating the association between menopausal symptoms and sexual dysfunction among perimenopausal women and identifying the mediating effects of depression and anxiety on this association.

Patients and Methods

Data for the present cross-sectional study were collected from participants via Arabic versions of three questionnaires; the modified Menopausal Rating Scale (MRS), the Female Sexual Functioning Index (FSFI) and the Hospital Anxiety and Depression scale (HADS).

Results

Our study was conducted on 149 females with age ranged from 45 to 55 years. On studying the relation between modified MRS and HADS, the menopausal symptoms were significantly high among female with high anxiety scores. Regarding the relationship between MRS and FSFI, women with anxiety and physical and mental exhaustion had significantly lower FSFI scores than women without such symptoms (19.2 [2-31.4] vs 21.7 [3.8-30.9], p = 0.04, respectively). Furthermore, there were statistically significant negative correlations between depression scores and sexual desire (r = -0.32, p < 0.001), arousal (r = -0.25, p = 0.003), and total FSFI scores (r = -0.27, p = 0.04).

Conclusion

Perimenopausal women experience a confluence of challenges related to depression, anxiety, and sexual dysfunction. Understanding the interconnectedness of hormonal and psychosocial factors is essential for tailored interventions aimed at improving mental health and sexual well-being during this transitional phase.

Can We Improve the Technique of Pelvic Floor Muscle Exercises in Postmenopausal Women Using a Single Electromyography Biofeedback Session? An Experimental Study

Background: The aim of this study was to assess the effect of a single session of EMG biofeedback in a group of postmenopausal women on improving technique in pelvic floor muscle (PFM) contractions (exercises). Methods: Sixty-two women aged 60 to 85 years (69 ± 4; mean ± SD) participated in the study. We assessed the technique of PFM exercises via surface electromyography (EMG) using a vaginal probe. A single assessment sequence consisted of 11 exercises involving the conscious contraction of the PFM, during which the order of activation for selected muscles was determined. We then awarded scores for exercise technique on a scale from 0 to 4, where 4 represented the best technique and 0 represented no activation of PFMs. In the second assessment, we used a biofeedback method to teach PFM exercise technique. Results: In total, 32% (n = 20) of the participants were unable to correctly perform the first PFM contraction, scoring 0.9 ± 0.79. After a single EMG biofeedback session, these women received 1.7 ± 1.08 scores (p = 0.003). In the tenth exercise, there was also a statistically significant improvement between the first (baseline) and second assessment (1.7 ± 1.34 and 2.15 ± 1.09, respectively; p = 0.037). For the remaining exercises, the results were not statistically significant, but we observed a positive trend of change. Conclusions: The use of a single EMG biofeedback session is an effective method of improving technique in PFM exercises in a group of women who initially performed them incorrectly.

Influence of pelvic floor disorders on sexuality in women

OBJECTIVE

To determine the association between different pelvic floor disorders and the presence of sexual dysfunction in women.

METHOD

An observational study of non-pregnant women was carried out in Spain in 2021 and 2022. To assess the presence of pelvic floor problems, the Pelvic Floor Distress Inventory (PFDI-20) was used, consisting of the subscales Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6; prolapse symptoms), Colorectal-Anal Distress Inventory (CRADI-8; colorectal symptoms), and Urinary Distress Inventory-6 (UDI-6; urinary symptoms). The validated tool, Female Sexual Function (FSF), was used to evaluate female sexual function.

RESULTS

In total, 1008 women participated. Of these, 288 (28.6%) had some type of sexual dysfunction. Regarding symptoms, 52 (5.2%) stated that they do not reach orgasm and 172 (17.1%) said they had never or occasionally felt sexual desire in the last month. Women with sexual dysfunctions had higher mean scores on the POPDI-6, CRADI-8, and UDI-6 subscales than those who did not have sexual dysfunction (P ≤ 0.005). Risk factors identified included being postmenopausal, with an adjusted odds ratio (aOR) of 2.98 (95% confidence interval [CI] 2.12-4.18), and a greater impact of the symptoms of pelvic floor problems as assessed by the PFDI-20 scale, in such a way that for each point increase the probability of sexual dysfunction increases with an aOR of 1.008 (95% CI 1.005-1.011).

CONCLUSION

Women with pelvic floor disorders and postmenopausal women present sexual dysfunction more frequently.

Association between pelvic floor muscle strength and sexual function based on PISQ-12-an analysis of data from a multicenter cross-sectional study on 735 nulliparae during pregnancy

Background

Pelvic floor muscle strength is well-known to be associated with female sexual function. However, there were a few studies that reported on the relationship between pelvic floor muscle strength and female sexual function in pregnant women, and the presented results were inconsistent. Nulliparae represent a specific cohort with simplicity to exclude confounding factors that are caused by parity. The present study aimed to explore the association of pelvic floor muscle strength and sexual function based on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) of nulliparae during pregnancy.

Methods

This is the second analysis of the baseline data from a randomized controlled trial (RCT), which aimed to study the protective efficacy of pelvic floor muscle training on stress urinary incontinence at 6th week postpartum (registration number: ChiCTR2000029618). Nulliparae aged 20-40 years with singleton pregnancy before 16 weeks of gestation were enrolled in this study, and data, including participants' demographic information, the Modified Oxford Scale (MOS), and PISQ-12, were collected. Eligible nulliparae were divided into two groups: Group MOS > 3 and Group MOS ≤ 3. Demographic information of the two groups was compared. Sexual function based on the PISQ-12 scores of the two groups was compared. A comparison of the PISQ-12 scores between the two groups was calculated by the Mann-Whitney U-test using SPSS version 23.0.

Results

A total of 735 eligible nulliparae were enrolled in this study. Along with MOS grading up, PISQ-12 scores tended to get lower. Of the 735 nulliparae, there were 378 and 357 participants included in Group MOS > 3 and Group MOS ≤ 3, respectively. The PISQ-12 scores of Group MOS > 3 were significantly lower than those of Group MOS ≤ 3 (11 vs. 12, p < 0.001). The scores of the frequency of feeling sexual desire, orgasm achievement, sexual excitement, sexual activity satisfaction, sexual intercourse pain, fear of urinary incontinence, and negative emotion reactions with the sexual intercourse of Group MOS > 3 were lower than those of Group MOS ≤ 3 (p < 0.05).

Conclusion

Pelvic floor muscle strength was positively associated with sexual function based on the questionnaire of young nulliparae during their first trimester. Up to half of the nulliparae during the first trimester were suffering from weak pelvic floor muscle strength and nearly a quarter of the nulliparae were facing this weakness combined with sexual dysfunction.

Trial registration

This study has been registered at http://www.chictr.org.cn (registration number: ChiCTR2000029618).