Pelvic floor muscle training for urinary symptoms, vaginal prolapse, sexual function, pelvic floor muscle strength, and quality of life after hysterectomy: a systematic review with meta-analyses

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BackgroundAfter hysterectomy, women could experience pelvic floor dysfunction and negative impact on quality of life, which could be improved by pelvic floor muscle training. ObjectiveTo investigate effects of pelvic floor muscle training on urinary symptoms, vaginal prolapse, sexual function, pelvic floor muscle strength, and quality of life after hysterectomy. MethodsSystematic review with meta-analyses of randomized controlled trials. Trials with pelvic floor muscle training in women after hysterectomy were included. The outcomes measures were urinary symptoms, vaginal prolapse, sexual function, pelvic floor muscle strength, and quality of life. Quality of evidence was assessed by adopting the GRADE approach. ResultsSix trials, involving 776 participants, were included. The mean PEDro score of trials was 5.5. Moderate-quality evidence suggested that pelvic floor muscle training improves sexual function by 5 points (95% CI: 4, 6) on the Female Sexual Function Index, compared with no intervention. It might affect strength (SMD 0.5; 95% CI: −0.4, 1.3), quality of life (SMD 0.5 points out of 108, 95% CI: −0.1, 0.9), urinary symptoms (RD −0.02; 95% CI: −0.06, 0.1); however, the estimates were too imprecise. In addition, it produces no or negligible effects on vaginal prolapse (RD 0; 95% CI: −0.1, 0.1). Long-term effects remain uncertain. ConclusionThis systematic review provides moderate-quality evidence that pelvic floor muscle training is effective for improving women's sexual function after hysterectomy, in comparison with no intervention. Benefits on urinary symptoms, pelvic floor muscle strength, quality of life, and vaginal prolapse remains unclear. Also, the effects beyond the intervention period remains uncertain.