The effect of pelvic floor muscle exercises on female sexual function during pregnancy and the first three months postpartum

It is estimated that around 63% to 93% of women experience sexual dysfunction during pregnancy and over 90% of postpartum women report sexual problems in the first three months after birth. Even though pelvic floor muscle exercises (PFME) are recommended for healthy sexual function, the current evidence about the effect of antenatal PFME on female sexual function (FSF) and childbirth is unclear. There is also conflicting evidence for the effect of antenatal PFME on prevention of urinary and faecal incontinence symptoms during pregnancy and the postpartum period. The randomised controlled trial (RCT) reported in this thesis primarily aimed to investigate the effect of antenatal PFME on FSF during pregnancy and at three months after birth, and secondarily the effect on childbirth outcomes and urinary and faecal incontinence symptoms during pregnancy and the first three months after birth. A meta-analysis of published papers was also performed to examine the effect of PFME on childbirth outcomes. Eligible women who were less than 22 weeks gestation were recruited from the antenatal clinics of a tertiary hospital setting in Western Sydney, Australia. No statistically significant effect of PFME was found on FSF, childbirth outcomes, urinary and faecal incontinence symptoms. The results of this RCT need to be interpreted cautiously considering a 50% adherence rate with PFME and 40% of women not resuming sexual intercourse by three months postpartum. Some trends were seen in childbirth outcomes and faecal incontinence. A higher compliance rate and a larger sample size may have shown statistically significant findings. The meta-analysis, however, showed PFME did reduce severe perineal trauma and duration of labour significantly and is now cited as evidence in the Australian Third- and Fourth-Degree Perineal Tears Clinical Care Standard (2021). More research is recommended into the effect of PFME on FSF, childbirth outcomes and urinary and faecal incontinence during pregnancy and postpartum. The optimal frequency and ideal PFME protocol also need further examination

Childbirth and sexuality

Throughout documented history and across cultures childbirth has been memorialized as both mystery and power, and those who attended women giving birth, mostly midwives, have been both revered and feared (Ehrenreich & English, 2010). It is only relatively recently that childbirth has been made public, its mysteries exposed through media and technologies like ultrasound and men have been permitted to enter the birth space. In many countries around the world midwives have been usurped as lead care providers at birth with a concerted attempt to eradicate them in some places; and this continues even today (Clifford, 2019; Greenfield, 2019)

The effect of antenatal pelvic floor muscle exercises on labour and birth outcomes : a systematic review and meta-analysis

Introduction and hypothesis: The current data on the effectiveness of antenatal pelvic floor muscle exercises (PFME) on childbirth outcomes are limited. Therefore, in this study the effect of antenatal PFMEs on labour and birth outcomes was assessed by undertaking a meta-analysis. Methods: Databases were systematically searched from 1988 until June 2019. Randomised controlled trials (RCTs) and quasi-experimental studies were included. The methodological quality of studies was assessed using Cochrane Collaboration tools. The outcomes of interest were: duration of first and second stage of labour, episiotomy and perineal outcomes, mode of birth (spontaneous vaginal birth, instrumental birth and caesarean section) and fetal presentation. The mean difference (MD) and risk ratio RR) with the corresponding 95% confidence intervals (CIs) were calculated to assess the association between PFME and the childbirth outcomes. Results: A total of 16 articles were included (n = 2,829 women). PFME shortened the duration of the second stage of labour (MD: −20.90, 95%, CI: −31.82 to −9.97, I2: 0%, p = 0.0002) and for primigravid women (MD: -21.02, 95% CI: −32.10 to −9.94, I2: 0%, p = 0.0002). PFME also reduced severe perineal lacerations (RR 0.57, 95% CI: 0.38 to 0.84, I2: 30%, p = 0.005). No significant difference was seen in normal vaginal birth, caesarean section, instrumental birth and episiotomy rate. Most of the studies carried a moderate to high risk of bias. Conclusion: Antenatal PFME may be effective at shortening the second stage of labour and reducing severe perineal trauma. These findings need to be interpreted considering the included studies’ risk of bias. More high-quality RCTs are needed

The effect of pelvic floor muscle exercise on female sexual function during pregnancy and postpartum : a systematic review

Introduction: Pelvic floor muscle exercise (PFME) is recommended as a first-line treatment for urinary incontinence. However, a review of the literature suggests the effect of PFME on sexual function (SF), particularly during pregnancy and the postpartum period, is understudied. Aim: To assess the effect of PFME on SF during pregnancy and the postpartum period. Methods: The following databases were searched: CINAHL (EBSCOhost), Health Collection (Informit), PubMed (National Center for Biotechnology Information), Embase (Ovid), MEDLINE, Cochrane, Health Source, Scopus, Wiley, Health & Medical Complete (ProQuest), Joanna Briggs Institute, and Google Scholar. Results from published randomized controlled trials (RCTs) and non-RCTs from 2004 to January 2018 on pregnant and postnatal women were included. PEDro and Critical Appraisal Skills Programme scores were used to assess the quality of studies. Data were analysed using a qualitative approach. Main Outcome Measure: The primary outcome was the impact of antenatal or postnatal PFME on at least 1 SF variable, including desire, arousal, orgasm, pain, lubrication, and satisfaction. The secondary outcome was the impact of PFME on PFM strength. Results: We identified 10 studies with a total of 3607 participants. These included 4 RCTs, 1 quasi-experimental study, 3 interventional cohort studies, and 2 long-term follow up cohort studies. No studies examined the effect of PFME on SF during pregnancy. 7 studies reported that PFME alone improved sexual desire, arousal, orgasm, and satisfaction in the postpartum period. Conclusion: The current data needs to be interpreted in the context of the studies’ risk of bias, small sample sizes, and varying outcome assessment tools. The majority of the included studies reported that postnatal PFME was effective in improving SF. However, there is a lack of studies describing the effect of PFME on SF during pregnancy, and only minimal data are available on the postpartum period. More RCTs are needed in this area

Evaluation of the effect of an antenatal pelvic floor muscle exercise programme on female sexual function during pregnancy and the first 3 months following birth : study protocol for a pragmatic randomised controlled trial

Background: Sexual dysfunction can have a negative impact on women’s quality of life and relationships. There is limited information about female sexual function and treatment, particularly during pregnancy and the postpartum period. The effect of pelvic floor muscle exercise (PFME) on sexual function (SF) has not been studied adequately. The purpose of this study is to investigate the effect of antenatal PFME on female SF during pregnancy and the first 3 months following birth. Methods/design: This is a pragmatic, randomised controlled trial which will compare a structured antenatal PFME programme combined with standard antenatal care to standard antenatal care alone. Eligible women who are less than 22 weeks’ gestation will be recruited from the antenatal clinics of one hospital located in Western Sydney, Australia. A sample of 200 primiparous pregnant women who meet the inclusion criteria will be randomised to either control or intervention groups. This sample size will allow for detecting a minimum difference of 9% in the female SF score between the two groups. The duration of the PFME programme is from approximately 20 weeks’ gestation until birth. Female SF will be measured via questionnaires at < 22 weeks’ gestation, at 36 weeks’ gestation and at 3 months following birth. Baseline characteristics, such as partner relationship and mental health, will be collected using surveys and questionnaires. Data collected for secondary outcomes include the effect of PFME on childbirth outcomes, urinary and faecal incontinence symptoms and quality of life. Discussion: The findings of this study will provide more information on whether a hospital-based antenatal PFME has any effect on female SF, urinary and faecal incontinence during pregnancy and the first 3 months following birth. The study will also provide information on the effectiveness of antenatal PFME on childbirth outcomes

The effect of antenatal pelvic floor muscle exercise on sexual function and labour and birth outcomes : a randomised controlled trial

Background: Pelvic floor muscle exercises (PFME) are recommended for treatment of urinary incontinence with less evidence available about the effect on female sexual function (FSF) and childbirth. Aim: To investigate the effect of antenatal PFME on FSF during pregnancy and the first three months following birth as a primary outcome, and on labour and birth outcomes as a secondary outcome. Method: 200 nulliparous women were randomised to control (n = 100) and intervention (n = 100) groups. The women in the intervention group (IG) undertook PFME from 20 weeks gestation until birth and had routine antenatal care, while those in the control group (CG) received routine antenatal care only. The Female Sexual Function Index (FSFI) was used to measure FSF at 36 weeks gestation and three months postnatal. Baseline characteristics and childbirth data were also collected and analysed using SPSS. Results: There were no statistically significant differences between the two groups in terms of FSF scores during pregnancy and on childbirth outcomes. Sexual satisfaction was slightly higher in the CG [Mean ± SD, CG: 4.35 ± 1.45 vs. IG: 3.70 ± 1.50, (P = 0.03)] at three months after birth. However, 50% of women adhered to the PFME, and 40% of women did not resume sex by three months after the birth. Conclusion: Though some trends were observed, the results showed no effect of PFME on sexual function or labour and birth outcomes. This needs to be interpreted considering the 50% adherence to PFME. More research is recommended