Effect of pain management, supervised exercise, and pelvic floor muscle training on sexual function in women with endometriosis: A randomized controlled trial

INTRODUCTION: Pelvic and genital pain is a common symptom among women with endometriosis and may negatively affect sexual functioning. Pelvic floor muscle training (PFMT) may improve sexual functioning, but whether this applies to women with endometriosis remains to be explored. This study is a planned secondary analysis in which we aimed to examine how general exercise and PFMT, when added to pain management, affect sexual functioning among women with endometriosis. MATERIAL AND METHODS: Planned secondary analysis of a two-armed, parallel-group randomized controlled trial with intention-to-treat analysis. Women aged 18-45 years with laparoscopically confirmed endometriosis and experiencing pelvic/genital pain were eligible. All participants attended a pain management course. In addition to weekly home training, the exercise group (n = 41) participated in weekly supervised general exercise training, including PFMT, for 4 months. The control group (n = 40) received no further intervention. Between-group differences in sexual function were assessed using the total score of the Female Sexual Function Index (FSFI) at the end of the 4-month intervention and at the 12-month follow-up. We also examined differences in the subdomains-desire, arousal, lubrication, orgasm, satisfaction, and pain-at these time points. CLINICAL TRIAL REGISTRATION: NCT05091268. RESULTS: Four months post-intervention, the exercise group showed significantly higher total FSFI scores compared to the control group (mean difference = 3.52, 95% CI 0.49-6.54, p = 0.023). Significant between-group differences were also observed for the subdomains lubrication (mean difference = 0.90, 95% CI 0.17-1.63, p = 0.016) and orgasm (mean difference = 0.81, 95% CI 0.07-1.55, p = 0.033). No significant between-group differences were found for desire, arousal, or pain at the end of the 4-month intervention, or at 12 months follow-up for any domain. CONCLUSIONS: The findings suggest that the combined intervention of supervised exercise and PFMT, when added to pain management, may lead to short-term improvements in sexual function at the end of the 4-month intervention. Whether this effect is attributable to general exercise, PFMT, or their combination cannot be determined from the present study. However, the findings should be interpreted cautiously due to differences in sexual activity status between groups.