Introduction and hypothesis
We performed a review of the literature reporting on the effects of pelvic floor muscle training (PFMT) on female sexual function (SF).
Methods
Pubmed (from 1946 to ...December 2014), Ovid Medline (from 1946 to December 2014), CINAHL (from 1937 to December 2014), PsycINFO (from 1805 to December 2014), Scopus and Cochrane Central Register of Controlled Trials were searched by two independent reviewers. Randomised controlled trials (RCTs) investigating the impact of PFMT on women’s SF published in English were included. Methodological quality was scored using the PEDro scale. Data were analysed qualitatively and interpreted.
Results
A total of 1341 women were included in the eight RCTs covered by this review. The studies were published between 1997 and 2014. Methodological scores were between 4 and 7. The sample included derived from heterogeneous populations of women. In only one study was SF the primary outcome measure. Pelvic floor dysfunction was an inclusion criterion in the majority of studies. Most studies reported a significant improvement in SF score after PFMT between control and intervention groups.
Conclusions
Although most studies indicated an improvement of at least one sexual variable in women with pelvic floor dysfunction, and one study demonstrated an improvement in SF in postpartum women selected independently of their continence status, the results need to be interpreted with caution. High-quality RCTs specifically designed to investigate the impact of PFMT on women’s SF are required.
Abstract Question Does an educational program with instructions for performing ‘the Knack’ improve voluntary contraction of the pelvic floor muscles, reduce reports of urinary incontinence, improve ...sexual function, and promote women’s knowledge of the pelvic floor muscles? Design Randomised, controlled trial with concealed allocation, intention-to-treat analysis and blinded assessors. Participants Ninety-nine women from the local community. Intervention The experimental group (n = 50) received one lecture per week for 4 weeks, and instructions for performing ‘the Knack’. The control group (n = 49) received no intervention. Outcome measures The primary outcome was maximum voluntary contraction of the pelvic floor muscles measured using manometry. Secondary outcomes were: ability to contract the pelvic floor muscles measured using vaginal palpation; severity of urinary incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scored from 0 to 21; self-reported sexual function; and knowledge related to the pelvic floor. Outcomes were measured at baseline and after 4 weeks. Results The intervention did not significantly improve: maximum voluntary contraction (MD 2.7 cmH2 O higher in the experimental group, 95% CI –0.5 to 5.9); ability to contract the pelvic floor muscles (RR 2.18, 95% CI 0.49 to 9.65); or self-reported severity of urinary incontinence (MD 1 point greater reduction in the experimental group, 95% CI –3 to 1). Sexual function did not significantly differ between groups, but very few of the women engaged in sexual activity during the study period. The educational program did, however, significantly increase women’s knowledge related to the location, functions and dysfunctions of the pelvic floor muscles, and treatment options. Conclusion Education and teaching women to perform ‘the Knack’ had no significant effect on voluntary contraction of the pelvic floor muscles, urinary incontinence or sexual function, but it promoted women’s knowledge about the pelvic floor. Trial registration Brazilian Registry of Clinical Trials, RBR-95sxqv. de Andrade RL, Bø K, Antonio FI, Driusso P, Mateus-Vasconcelos ECL, Ramos S, Julio MP, Ferreira CHJ (2018) An education program about pelvic floor muscles improved women’s knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial. Journal of Physiotherapy 64: 91–96
Abstract
Objective
We sought to investigate whether women present adequate knowledge of the main pelvic floor disorders (PFDs) (urinary incontinence – UI, fecal incontinence – FI, and pelvic organ ...prolapse – POP).
Data sources
A systematic review was performed in the MEDLINE, PEDro, CENTRAL, and Cochrane databases for publications from inception to April 2018.
Selection of studies
A total of 3,125 studies were reviewed. Meta-analysis was not possible due to the heterogeneity of primary outcomes and the diversity of instruments for measuring knowledge. The quality of the articles included in the analysis was evaluated with the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies.
Data collection
Two authors performed data extraction into a standardized spreadsheet.
Data synthesis
Nineteen studies were included, comprising 11,512 women. About the methodological quality (NOS), most of the studies (n = 11) presented a total score of 6 out of 10. Validated questionnaires and designed pilot-tested forms were the most frequently used ways of assessing knowledge. Some studies were stratified by race, age, or group minorities. The most used questionnaire was the prolapse and incontinence knowledge questionnaire (PIKQ) (n = 5). Knowledge and/or awareness regarding PFD was low to moderate among the studies. Urinary incontinence was the most prevalent PFD investigated, and the most important risk factors associated with the lack of knowledge of the pelvic floor were: African-American ethnicity (n = 3), low educational level (n = 4), low access to information (n = 5) and socioeconomic status (n = 3).
Conclusion
Most women have a gap in the knowledge of pelvic floor muscle dysfunctions, do not understand their treatment options, and are not able to identify risk factors for these disorders.
Among women who have participated in group-based education about the pelvic floor, what are their perceptions of the program and the group format?
Exploratory longitudinal qualitative study.
...Community-dwelling women aged ≥ 18 years who participated in three or four sessions of pelvic floor education in a group format at a university clinic.
Semi-structured group or individual interviews were conducted at three time points: 1 week, 3 months and ≥ 5 months after the education activity. Data were inductively content analysed and independently coded, with iterative theme development.
Women considered the content and delivery appropriate and useful. New knowledge was assimilated and shared with others, and many tried to adopt pelvic floor muscle training in daily life. The women felt that the education sessions might benefit other women, with and without pelvic floor dysfunction symptoms, and that such education would ideally be more widely available. A perception of the value of the education persisted over time, even though maintenance of some health-promoting behaviours, such as pelvic floor muscle training, decreased.
The pelvic floor group education sessions appeared to fulfil the purpose of increasing knowledge about pelvic floor (dys)function and applying this in daily life. Overall, the participants, who had completed three or four of the four sessions, found the program to be useful. A unique feature of this study was longitudinal data collection and it seemed that the perception of value persisted over time.
Introduction and hypothesis
The literature presents controversial results regarding the role of delivery mode in pelvic floor muscle (PFM) function after birth. Some studies showed a greater ...impairment of PFM function after vaginal delivery compared with cesarean section, while others have not identified a significant difference between these two modes of delivery. This study aimed to investigate whether there was a difference in short-term PFM function after childbirth in primiparous women who underwent cesarean section compared with those who underwent vaginal delivery.
Methods
Up to December 2018, the PubMed-MEDLINE, CINAHL, Embase, Bireme, Scopus, Web of Science, and Science Direct databases were searched. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. Observational studies comparing PFM function after cesarean section versus vaginal delivery in primiparous women were included. PRISMA guidelines and Cochrane recommendations were followed. Methodological quality of the primary studies was assessed through the checklist proposed by the Joanna Briggs Institute for cross-sectional studies. Random effects meta-analysis was performed to synthesize evidence regarding PFM strength in primiparous woman after vaginal delivery compared with cesarean section. The GRADE approach was applied to classify the quality of the evidence.
Results
Eleven studies met the inclusion criteria and were included in this review. A total of 1726 primiparous women were analyzed after childbirth. Five studies were included in the meta-analysis. No difference in PFM strength after childbirth was identified when cesarean section was compared with vaginal delivery standardized mean difference (SMD): −0.15, 95% confidence interval (CI): −0.85 to 0.56. Differences in PFM strength were identified when patients who underwent cesarean section were compared with those with an episiotomy or instrumented vaginal delivery (SMD: −12.51, CI 95%: −24.57 to −0.44), favoring the cesarean section group. In both cases, the quality of evidence was classified as very low because of the observational design of the included studies and population heterogeneity.
Conclusion
There was no difference in short-term PFM strength after childbirth between primiparous women who underwent cesarean section or vaginal delivery, as assessed through vaginal manometry. However, we identified reduced PFM strength in women who underwent an episiotomy or instrumented vaginal delivery compared with those who underwent cesarean section. Nevertheless, this conclusion should be cautiously considered as the observational design of the primary studies and possible heterogeneity among the primiparous women included in the studies contributed to reducing the quality of the evidence synthesized. Future primary studies with longitudinal designs and long-term follow-up periods are needed to strengthen the quality of evidence and provide more conclusive evidence to guide clinical practice.
Introduction and hypothesis
There seems to be little knowledge about pelvic floor muscles (PFMs) in the general population; however, literature confirming this assertion is scarce, especially in ...developing countries. The present study hypothesized a low level of knowledge about PFMs in a sample of Brazilian women and a positive relationship between that knowledge and the ability to contract the PFMs, strength, and urinary continence.
Methods
This was a cross-sectional study including 133 women. A questionnaire assessing knowledge about PFMs and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) were applied. Vaginal palpation and manometry were used to assess PFM condition. Pearson’s correlation coefficient was used to test the association between PFM knowledge and continuous variables, and Fisher’s exact test was used to compare the women’s PFM knowledge with the categorical variables.
Results
A low level of PFM knowledge was observed in this sample, with a mean total score of 0.48 (±0.97). Vaginal manometry peak, mean, and duration values were 39.1 cmH
2
O (±23.7), 25.5 cmH
2
O (±16.1), and 21.1 s (±20.8) respectively. The ICIQ-UI-SF mean score was 7.1 (± 6.8). There were weak correlations between PFM knowledge and age (r −0.2044/
p
= 0.01), and parity (r −0.19568/
p
= 0.02). PFM knowledge was higher among women with higher education levels (
p
= 0.0012) and those who had previously performed PFM training (
p
<0.001).
Conclusion
The participants showed a low level of PFM knowledge. No relationship between PFM knowledge and ability to contract or prevalence of UI was observed.
Introduction and aim
Physiotherapy in urogynecology faces challenges to safely continuing its work, considering the adoption of social distancing measures during the COVID-19 pandemic. Some ...guidelines have already been published for urogynecology; however, no specific documents have been produced on physiotherapy in urogynecology. This article aimed to offer guidance regarding physiotherapy in urogynecology during the COVID-19 pandemic.
Methods
A group of experts in physiotherapy in women’s health performed a literature search in the Pubmed, PEDro, Web of Science and Embase databases and proposed a clinical guideline for physiotherapy management of urogynecological disorders during the COVID-19 pandemic. This document was reviewed by other physiotherapists and a multidisciplinary panel, which analyzed the suggested topics and reached consensus. The recommendations were grouped according to their similarities and allocated into categories.
Results
Four categories of recommendations (ethics and regulation issues, assessment of pelvic floor muscle function and dysfunction, health education and return to in-person care) were proposed. Telephysiotherapy and situations that need in-person care were also discussed. Regionalization is another topic that was considered.
Conclusion
This study provides some guidance for continuity of the physiotherapist's work in urogynecology during the COVID-19 pandemic, considering the World Health Organization recommendations and the epidemiological public health situation of each region. Telephysiotherapy can also be used to provide continuity of the care in this area during the COVID-19 pandemic, opening new perspectives for physiotherapy in urogynecology.
Aim
To perform a systematic review of available mHealth apps for menstrual cycle monitoring in Brazil.
Methods
A search for menstrual cycle mHealth apps from the Google Play Store and AppStore in ...Brazil was performed by two independent reviewers on October 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS).
Results
Our review identified 2400 potentially relevant mHealth apps, of which 56 were eligible for inclusion. The majority of the apps offered tools to track menstruation symptoms (63%) and educational content for users (32%). The mean ( ±SD) MARS app quality score for the 28 evaluated apps in Android was 3.5 ± 0.6 on a 0–5 scale. For the 28 evaluated apps in iOS, the mean app quality score was 3.8 ± 0.4. Most of the included apps, for both systems, scored average for credibility, user interface, and engagement.
Conclusion
The majority of available tools in Brazil are of moderate quality and limited functionality for menstrual cycle monitoring. This study highlights the top three mHealth apps available on each online store for individuals seeking menstrual cycle monitoring options.
Introduction and hypothesis
The prevalence of sexual dysfunction in postmenopausal women is high. Theoretically pelvic floor muscle (PFM) strength could influence sexual function, but to date there ...is scant evidence on this topic. The aim of this study was to evaluate the relationship between PFM strength and sexual function in postmenopausal women. The relationship between reported urinary incontinence (UI) and sexual dysfunction was also investigated.
Methods
This was a cross-sectional study including 113 postmenopausal women. PFM strength was evaluated using vaginal manometry. Sexual function was evaluated using the Female Sexual Function Index (FSFI). A score of ≤26.5 was considered to indicate sexual dysfunction. Urinary incontinence reports were evaluated using the International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) Short Form. Statistical analysis was performed using Spearman’s rank correlation coefficient (
ρ
), the Mann–Whitney test and 95 % confidence intervals.
Results
The median age of the women was 53 years (range 42 – 65 years) and their median body mass index was 27.9 kg/m
2
(range 20 – 42 kg/m
2
). Women without sexual dysfunction showed significantly higher PFM strength (median 41.8, range 11.3 – 94.0 cmH
2
O) than women with sexual dysfunction (median 30.3, range 3 – 112 cmH
2
O;
p
= 0.02). A weak correlation was found between the total FSFI score and the total ICIQ-UI score (
ρ
= −0.21,
p
= 0.03).
Conclusions
Postmenopausal women with sexual dysfunction showed lower PFM strength than women without sexual dysfunction. There was a weak correlation between urinary incontinence severity and sexual function.
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