Is voluntary pelvic floor muscles contraction important for sexual function in women with pelvic floor disorders?

Abstract

To investigate relationships between pelvic floor muscles (PFM) and sexual function (SF) in sexually active (SA) and not-SA (NSA) women with pelvic floor disorders (PFD). In 350 women with PFD: 173(49.4%) SA, 177(50.6%) NSA, Pelvic Organ Prolapse (POP)-Quantification, PFM tone, and strength were evaluated. Transperineal ultrasound (TPS) measured genital hiatus (GH) diameter, bladder neck (BN) movement. Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), and Female Sexual Function Index (FSFI) were used. SA women were dichotomized according to muscle strength (weak/strong) and tone (normal/hypoactive). FSFI scores reflected sexual dysfunction in 63.5% SA women. 32.2% partnered NSA stated PFD the reason for sexual inactivity. NSA women had higher POP stages and hypoactive PFM rates compared to SA: 72 (40.7%) vs 52 (30.1%), P = .04. TPS GH diameter did not differ between SA and NSA at rest, contraction, and did not correlate with SF. BN length was longer in SA at rest (15.0 ± 7.0 vs 13.1 ± 9.4, P = .03) and contraction (19.7 ± 7.0 vs 16.7 ± 10.2, P = .006); 30 (8.6%) subjects depressed BN during contraction. GH change at contraction correlated with Oxford Grading Scale (rps = 0.41; P < .001), and was smaller in women with nonfunctioning vs normal/underactive PFM (P < .001). Women with hypoactive PFM had lower SF in PISQ-IR Global quality and FSFI Desire domains vs normal tone. BN length at rest, contraction, and total mobility correlated with several PISQ-IR and FSFI domains. In SA women with PFD, lower rates of hypoactive PFM tone were found. The ability to contract PFM did not influence SF. Greater mobility of BN correlated with lower SF.