Advertisement

REVIEWS: Pelvic Floor Involvement in Male and Female Sexual Dysfunction and the Role of Pelvic Floor Rehabilitation in Treatment: A Literature Review

      ABSTRACT

      Introduction

      The sphincteric and supportive functions of the pelvic floor are fairly well understood, and pelvic floor rehabilitation, a specialized field within the scope and practice of physical therapy, has demonstrated effectiveness in the treatment of urinary and fecal incontinence. The role of the pelvic floor in the promotion of optimal sexual function has not been clearly elucidated.

      Aim

      To review the role of the pelvic floor in the promotion of optimal sexual function and examine the role of pelvic floor rehabilitation in treating sexual dysfunction.

      Main Outcome Measure

      Review of peer-reviewed literature.

      Results

      It has been proposed that the pelvic floor muscles are active in both male and female genital arousal and orgasm, and that pelvic floor muscle hypotonus may impact negatively on these phases of function. Hypertonus of the pelvic floor is a significant component of sexual pain disorders in women and men. Furthermore, conditions related to pelvic floor dysfunction, such as pelvic pain, pelvic organ prolapse, and lower urinary tract symptoms, are correlated with sexual dysfunction.

      Conclusions

      The involvement of the pelvic floor in sexual function and dysfunction is examined, as well as the potential role of pelvic floor rehabilitation in treatment. Further research validating physical therapy intervention is necessary. Rosenbaum TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: A literature review. J Sex Med 2007;4:4–13.

      Keywords

      To read this article in full you will need to make a payment
      ISSM Member Login
      Login with your ISSM username and password.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hay-Smith E.J.
        • Bo Berghmans L.C.
        • Hendriks HJ.
        • De Bie R.A.
        • Van Waalwijk van Doorn E.S.
        Pelvic floor muscle strengthening for urinary incontinence in women.
        Cochrane Database Syst Rev. 2001; 14
        • Graziottin A.
        • Bottanelli M.
        • Bertolasi L.
        Vaginismus: A clinical and neurophysiological study.
        Urodinamica. 2004; 14: 117-121
        • Messelink B.
        • Benson T.
        • Berghmans B.
        • Bo K.
        • Corcos J.
        • Fowler C.
        • Laycock J.
        • Huat-Chye Lim P.
        • Van Lunsen R.
        • Lycklama à Nijeholt G.
        • Pemberton J.
        • Wang A.
        • Watier A.
        • Van Kerrebroeck P.
        Standardization of terminology of pelvic floor muscle function and dysfunction. Report from the pelvic floor clinical assessment group of the International Continence Society.
        Neurourol Urodyn. 2005; 24: 374-380
        • Wilmore J.
        • Costill D.
        Physiology of sport and exercise. 2nd edn. Human Kinetics Inc., Champaign, IL1999
        • Bo K.
        • Sherburn M.
        Evaluation of female pelvic floor muscle function and strength.
        Phys Ther. 2005; 85: 269-282
        • Laycock J.
        • Schussler B.
        • Norton P.
        • Stanton S.
        Pelvic floor re-education: Principles and practice. Springer-Verlag, London1994
        • Reissing E.D.
        • Binik Y.M.
        • Khalifé S.
        • Cohen D.
        • Amsel R.
        Vaginal spasm, pain, and behavior: An empirical investigation of the diagnosis of vaginismus.
        Arch Sex Behav. 2004; 33: 5-17
        • Saenz de Tejada I.
        • Angulo J.
        • Cellek S.
        • Gonzalez-Cadavid N.
        • Heaton J.
        • Pickard R.
        • Simonsen U.
        Physiology of erectile function.
        J Sex Med. 2004; 1: 254-265
        • McMahon C.G.
        • Abdo C.
        • Incrocci L.
        • Perelman M.
        • Rowland D.
        • Waldinger M.
        • Xin Z.C.
        Disorders of orgasm and ejaculation in men.
        J Sex Med. 2004; 1: 58-65
        • Claes H.
        • Baert L.
        Pelvic floor exercise versus surgery in the treatment of impotence.
        Br J Urol. 1993; 71: 52-57
        • Morales A.
        • Buvat J.
        • Gooren L.J.
        • Guay A.T.
        • Kaufman J.M.
        • Tan H.M.
        • Torres L.O.
        Endocrine aspects of sexual dysfunction in men.
        J Sex Med. 2004; 1: 69-81
        • Hatzichristou D.
        • Rosen R.C.
        • Broderick G.
        • Clayton A.
        • Cuzin B.
        • Derogatis L.
        • Litwin M.
        • Meuleman E.
        • O’Leary M.
        • Quirk F.
        • Sadovsky R.
        • Seftel A.
        Clinical evaluation and management strategy for sexual dysfunction in men and women.
        J Sex Med. 2004; 1: 49-57
        • Van Kampen M.
        • De Weerdt W.
        • Claes H.
        • Feys H.
        • De Maeyer M.
        • Van Poppel H.
        Treatment of erectile dysfunction by perineal exercise, electromyographic biofeedback, and electrical stimulation.
        Phys Ther. 2003; 83: 536-543
        • Dorey G.
        • Speakman M.J.
        • Feneley R.C.
        • Swinkels A.
        • Dunn C.D.
        Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction.
        Br J Gen Pract. 2004; 54: 819-825
        • Piediferro G.
        • Colpi E.M.
        • Castiglioni F.
        • Scroppo F.I.
        Premature ejaculation. 3. Therapy.
        Arch Ital Urol Androl. 2004; 76: 192-198
        • La Pera G.
        • Nicastro A.
        A new treatment for premature ejaculation: The rehabilitation of the pelvic floor.
        J Sex Marital Ther. 1996; 22: 22-26
        • Chambless D.L.
        • Sultan F.E.
        • Stern T.E.
        • O’Neill C.
        • Garrison S.
        • Jackson A.
        Effect of pubococcygeal exercise on coital orgasm in women.
        J Consult Clin Psychol. 1984; 52: 114-118
        • Graber G.
        • Kline-Graber G.
        Female orgasm: Role of the pubococcygeus muscle.
        J Clin Psychiatry. 1979; 40: 348-351
        • Shafik A.
        The role of the levator ani muscle in evacuation, sexual performance, and pelvic floor disorders.
        Int Urogynecol J Pelvic Floor Dysfunct. 2000; 11: 361-376
        • Bo K.
        • Talseth T.
        • Vinsnes A.
        Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women.
        Acta Obstet Gynecol Scand. 2000; 79: 598-603
        • Beji N.K.
        • Yalcin O.
        • Erkan H.A.
        The effect of pelvic floor training on sexual function of treated patients.
        Int Urogynecol J Pelvic Floor Dysfunct. 2003; 14: 234-238
        • Salonia A.
        • Zanni G.
        • Nappi R.E.
        • Briganti A.
        • Deho F.
        • Fabbri F.
        • Colombo R.
        • Guazzoni G.
        • Di Girolamo V.
        • Rigatti P.
        • Montorsi F.
        Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: Results of a cross-sectional study.
        Eur Urol. 2004; 45: 642-648
        • Barber M.D.
        • Visco A.G.
        • Wyman J.F.
        • Fantl J.A.
        • Bump R.C.
        Sexual function in women with urinary incontinence and pelvic organ prolapse.
        Obstet Gynecol. 2002; 99: 281-289
        • Handa V.L.
        • Harvey L.
        • Cundiff G.W.
        • Siddique S.A.
        • Kjerulff K.H.
        Sexual function among women with urinary incontinence and pelvic organ prolapse.
        Am J Obstet Gynecol. 2004; 191: 751-756
        • Pauls R.N.
        • Berman J.R.
        Impact of pelvic floor disorders and prolapse on female sexual function and response.
        Urol Clin North Am. 2002; 29: 677-683
        • Rosen R.
        • Altwein J.
        • Boyle P.
        • Kirby R.S.
        • Lukacs B.
        • Meuleman E.
        • O’Leary M.P.
        • Puppo P.
        • Chris R.
        • Giuliano F.
        Lower urinary tract symptoms and male sexual dysfunction: The multinational survey of the aging male (MSAM-7).
        Progressive Urology. 2004; 14: 332-344
        • McVary K.
        Lower urinary tract symptoms and sexual dysfunction: Epidemiology and pathophysiology.
        BJU Int. 2006; 97: 23-28
        • Rosen R.C.
        Update on the relationship between sexual dysfunction and lower urinary tract symptoms/benign prostatic hyperplasia.
        Curr Opin Urol. 2006; 16: 11-19
        • Shiri R.
        • Hakkinen J.
        • Koskimaki J.
        • Huhtala H.
        • Auvinen A.
        • Hakama M.
        • Tammela T.L.
        Association between the bothersomeness of lower urinary tract symptoms and the prevalence of erectile dysfunction.
        J Sex Med. 2005; 2: 438-444
        • Moran P.A.
        • Dwyer P.L.
        • Ziccone S.P.
        Urinary leakage during coitus in women.
        J Obstet Gynaecol. 1999; 19: 286-288
        • Khan Z.
        • Bhola A.
        • Starer P.
        Urinary incontinence during orgasm.
        Urology. 1988; 31: 2279-2282
        • Mahoney D.T.
        Integral storage and voiding reflexes: Neurophysiologic concept of continence and micturition.
        Urology. 1977; 1: 95-107
        • Achtari C.
        • Dwyer P.
        Sexual function and pelvic floor disorders.
        Best Prac Res Clin Obstet Gynaecol. 2005; 19: 993-1008
        • De Leval J.
        Novel surgical technique for the treatment of female urinary stress incontinence: Transobdurator vaginal tape inside-out.
        Eur Urol. 2003; 44: 724-730
        • Yeni E.
        • Unal D.
        • Verit A.
        • Kafali H.
        • Ciftci H.
        • Gulum M.
        The effect of tension-free vaginal tape (TVT) procedure on sexual function in women with stress urinary incontinence.
        Int Urogynecol J Pelvic Floor Dysfunct. 2003; 14: 390-394
        • Holley R.L.
        • Varner R.E.
        • Gleason B.P.
        • Apffel L.A.
        • Scott S.
        Sexual function after sacrospinous ligament fixation for vaginal vault prolapse.
        J Reprod Med. 1996; 41: 355-358
        • Paraiso M.F.
        • Ballard L.A.
        • Walters M.D.
        • Lee J.C.
        • Mitchinson A.R.
        Pelvic support defects and visceral and sexual function in women treated with sacrospinous ligament suspension and pelvic reconstruction.
        Am J Obstet Gynecol. 1996; 175: 1423-1430
        • Goldberg R.P.
        • Tomezsko J.E.
        • Winkler H.A.
        • Koduri S.
        • Culligan P.J.
        • Sand P.K.
        Anterior or posterior sacrospinous vaginal vault suspension: Long-term anatomic and functional evaluation.
        Obstet Gynecol. 2001; 98: 199-204
        • Filocamo M.T.
        • Li Marzi V.
        • Del Popolo G.
        • Cecconi F.
        • Marzocco M.
        • Tosto A.
        • Nicita G.
        Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence.
        Eur Urol. 2005; 48
        • Floratos D.L.
        • Sonke G.S.
        • Rapidou C.A.
        • Alivizatos G.J.
        • Deliveliotis C.
        • Constantinides C.A.
        • Theodorou C.
        Biofeedback vs. verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy.
        BJU Int. 2002; 89: 714-719
        • Van Kampen M.
        • De Weerdt W.
        • Van Poppel H.
        • De Ridder D.
        • Feys H.
        • Baert L.
        Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: A randomised controlled trial.
        Lancet. 2000; 355: 98-102
        • Lewis R.W.
        • Fugl-Meyer K.S.
        • Bosch R.
        • Fugl-Meyer A.R.
        • Laumann E.O.
        • Lizza E.
        • Martin-Morales A.
        Epidemiology/risk factors of sexual dysfunction.
        J Sex Med. 2004; 1: 35-39
        • Lue T.F.
        • Giuliano F.
        • Montorsi F.
        • Rosen R.C.
        • Andersson K.E.
        • Althof S.
        • Christ G.
        • Hatzichristou D.
        • Hirsch M.
        • Kimoto Y.
        • Lewis R.
        • McKenna K.
        • MacMahon C.
        • Morales A.
        • Mulcahy J.
        • Padma-Nathan H.
        • Pryor J.
        • De Tejada I.S.
        • Shabsigh R.
        • Wagner G.
        Summary of the recommendations on sexual dysfunctions in men.
        J Sex Med. 2004; 1: 6-23
        • Titta M.
        • Tavolini I.M.
        • Moro F.D.
        • Cisternino A.
        • Bassi P.
        Sexual counseling improved erectile rehabilitation after non-nerve-sparing radical retropubic prostatectomy or cystectomy––Results of a randomized prospective study.
        J Sex Med. 2006; 3: 267-273
        • American Psychiatric Association.
        Diagnostic and statistical manual of mental disorders. 4th edn. American Psychiatric Association, Washington, DC2000
        • LoPiccolo J.
        Treating vaginismus [a video]. The Sinclair Institute, ChapelHill, NC1984
        • Masters W.H.
        • Johnson V.E.
        Human sexual inadequacy. Little, Brown, Boston, MA1970
        • Basson R.
        • Leiblum S.
        • Brotto L.
        • Derogatis L.
        • Fourcroy J.
        • Fugl-Meyer K.
        • Graziottin A.
        • Heiman J.
        • Laan E.
        • Meston C.
        • Schover L.
        • Van Lanveld J.
        • Weijmer Schultz W.
        Revised definitions of women’s sexual dysfunction.
        J Sex Med. 2004; 1: 40-48
        • Basson R.
        • Althof S.
        • Davis S.
        • Fugl-Meyer K.
        • Goldstein I.
        • Leiblum S.
        • Meston C.
        • Rosen R.
        • Wagner G.
        Summary of the recommendations on sexual dysfunctions in women.
        J Sex Med. 2004; 1: 24-34
        • Friedrich E.G.
        Therapeutic studies on vulvar vestibulitis.
        J Reprod Med. 1988; 33: 514-517
        • Weijmar Schultz W.
        • Basson R.
        • Binik Y.
        • Eschenbach D.
        • Wesselmann U.
        • Van Lankveld J.
        Women’s sexual pain and its management.
        J Sex Med. 2005; 2: 301-316
        • Bornstein J.
        • Sabo E.
        • Goldshmid N.
        • Abramovici H.
        A mathematical model for the histopathologic diagnosis of vulvar vestibulitis based on a histomorphometric study of innervation and mast cell activation.
        J Reprod Med. 2002; 9: 742
        • Bohm-Starke N.
        • Hilliges M.
        • Brodda-Jansen G.
        • Rylander E.
        • Torebjork E.
        Psychophysical evidence of nociceptor sensitization in vulvar vestibulitis syndrome.
        Pain. 2001; 94: 177-183
        • Witkin S.S.
        • Gerber S.
        • Ledger W.J.
        Influence of interleukin-1 receptor antagonist gene polymorphism on disease.
        Clin Infect Dis. 2002; 34: 204-209
        • Basson R.
        • Riley A.J.
        Vulvar vestibulitis syndrome: A common condition which may present as vaginismus.
        J Sex Marital Ther. 1994; 9: 221-224
        • De Kruiff M.E.
        • Ter Kuile M.M.
        • Weijenborg P.
        • Van Lankveld J.J.
        Vaginismus and dyspareunia: Is there a difference in clinical presentation?.
        J Psychosom Obstet Gynaecol. 2000; 21: 149-155
        • Goldstein A.
        Surgical techniques: Surgery for vulvar vestibulitis syndrome.
        J Sex Med. 2006; 3: 559-562
        • Bergeron S.
        • Binik Y.M.
        • Khalifé S.
        The treatment of vulvar vestibulitis syndrome: Toward a multimodal approach.
        J Sex Marital Ther. 1997; 23: 305-311
        • Holland A.
        Physical therapy intervention for dyspareunia: A case report.
        J Women’s Health Phys Ther, APTA. 2003; 27: 18-20
        • Reissing E.D.
        • Brown C.
        • Lord M.J.
        • Binik Y.M.
        • Khalifé S.
        Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome.
        J Psychosom Obstet Gynaecol. 2005; 26: 107-113
        • Rosenbaum T.Y.
        Physiotherapy treatment of sexual pain disorders.
        J Sex Marital Ther. 2005; 31: 329-340
        • Van Der Velde J.
        • Laan E.
        • Everaerd W.
        Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus.
        Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12: 328-331
        • Glazer H.I.
        • Rodke G.
        • Swencionis C.
        • Hertz R.
        • Young A.W.
        Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature.
        J Reprod Med. 1995; 40: 283-290
        • McKay E.
        • Kaufman R.H.
        • Doctor U.
        • Berkova Z.
        • Glazer H.
        • Redko V.
        Treating vulvar vestibulitis with electromyographic biofeedback of pelvic floor musculature.
        J Reprod Med. 2001; 46: 337-342
        • Bergeron S.
        • Binik Y.M.
        • Khalife S.
        • Pagidas K.
        • Glazer H.I.
        • Meana M.
        • Amsel R.
        A randomized comparison of group cognitive behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis.
        Pain. 2001; 91: 297-306
        • Tae Seo J.
        • Ho Choe Won S.L.
        • Hee Kim K.
        Efficacy of functional electrical stimulation biofeedback with cognitive behavioral therapy as treatment of vaginismus.
        Urology. 2005; 66: 77-81
        • Bergeron S.
        • Lord M.
        The integration of pelvi-perineal re-education and cognitive-behavioural therapy in the multidisciplinary treatment of sexual pain disorders.
        Sex Relationship Ther. 2003; 18: 135-141
        • Hartmann E.
        The perceived effectiveness of physical therapy treatment on women complaining of chronic vulvar pain and diagnosed with either vulvar vestibulitis syndrome or dysestheric vulvodynia.
        J Women’s Health Phys Ther, APTA. 2001; 25: 13-18
        • Bergeron S.
        • Brown C.
        • Lord M.J.
        • Oala M.
        • Binik Y.M.
        • Khalife S.
        Physical therapy for vulvar vestibulitis syndrome: A retrospective study.
        J Sex Marital Ther. 2002; 28: 183-192
        • Fitzgerald M.P.
        • Kotarinos R.
        Rehabilitation of the short pelvic floor. II. Treatment of the patient with the short pelvic floor.
        Int Urogynecol J Pelvic Floor Dysfunct. 2003; 14: 269-275
        • Hay-Smith E.J.
        Therapeutic ultrasound for postpartum perineal pain and dyspareunia.
        Cochrane Database Syst Rev. 2002; 14
        • Fitzwater J.B.
        • Kuehl T.J.
        • Schrier J.J.
        Electrical stimulation in the treatment of pelvic pain.
        J Reprod Med. 2003; 48: 573-577
        • Nappi R.E.
        • Ferdeghini F.
        • Abbiati I.
        • Vercesi C.
        • Farina C.
        • Polatti F.
        Electrical stimulation (ES) in the management of sexual pain disorders.
        J Sex Marital Ther. 2003; 29: 103-110
        • Gonen M.
        • Kalkan M.
        • Cenker A.
        • Ozkardes H.
        Prevalence of premature ejaculation in Turkish men with chronic pelvic pain syndrome.
        J Androl. 2005; 26: 601-603
        • Potts J.M.
        Chronic pelvic pain syndrome: A non-prostatocentric perspective.
        World J Urol. 2003; 21
        • Hetrick D.C.
        • Glazer H.
        • Liu Y.W.
        • Turner J.A.
        • Frest M.
        • Berger R.E.
        Pelvic floor electromyography in men with chronic pelvic pain syndrome: a case control study.
        Neurourol Urodyn. 2006; 25: 46-49
        • Cornel E.B.
        • Van Haarst E.P.
        • Schaarsberg R.W.
        • Geels J.
        The effect of biofeedback physical therapy in men with chronic pelvic pain syndrome type III.
        Eur Urol. 2005; 47
        • Ye Z.Q.
        • Cai D.
        • Du Lan R.Z.G.H.
        • Yuan X.Y.
        • Chen Z.
        • Ma Y.Z.
        • Hu Y.M.
        • Zeng G.Y.
        Biofeedback therapy for chronic pelvic pain syndrome.
        Asian J Androl. 2003; 5: 155-158
        • Wurn L.J.
        • Wurn B.F.
        • King C.R.
        • Roscow A.S.
        • Scharf E.S.
        • Shuster J.J.
        Increasing orgasm and decreasing dyspareunia by a manual physical therapy technique.
        MedGenMed. 2004; 6: 47

      Linked Article

      • ERRATA
        The Journal of Sexual MedicineVol. 4Issue 2
        • Preview
          The following manuscript published in the January 2007 issue of the JSM incorrectly credited Dr. Hessel Wijkstra, who was not an author on the manuscript: A Reproducibility Study of Corpus Cavernosum Electromyography in Young Healthy Volunteers Under Controlled Conditions
        • Full-Text
        • PDF
      • ERRATA
        The Journal of Sexual MedicineVol. 4Issue 2
        • Preview
          Goldstein I, Kim E, Steers WD, Pryor JL, Wilde DW, Natanegara F, Wong DG, Ahuja S. Efficacy and Safety of Tadalafil in Men with Erectile Dysfunction with a High Prevalence of Comorbid Conditions: Results from MOMENTUS: Multiple Observations in Men with Erectile Dysfunction in National Tadalafil Study in the US. J Sex Med 2007;4:166–75.
        • Full-Text
        • PDF
      • ERRATA
        The Journal of Sexual MedicineVol. 4Issue 2
        • Preview
          Young JM, Roehrborn CG, McVary KT, Kaminetsky JC, Auerbach SM, Wachs B, Esler A, Sides GD, Denes BS. The Efficacy and Safety of Tadalafil Administered Once a Day for Lower Urinary Tract Symptoms (Luts) in Men with Benign Prostatic Hyperplasia (BPH). J Sex Med 2007;4:S91.
        • Full-Text
        • PDF
      • ERRATA
        The Journal of Sexual MedicineVol. 4Issue 2