Structured Pelvic Floor Rehabilitation for Improving Conception Outcomes in PCOS Women with Occult Pelvic Floor Dysfunction
DOI:
https://doi.org/10.61919/jvs45524Keywords:
Conception, Female Sexual Function, Infertility, Pelvic Floor Dysfunction, Pelvic Floor Rehabilitation, Polycystic Ovary Syndrome, Quality of Life, Women’s HealthAbstract
Background: Polycystic ovary syndrome (PCOS) is a major cause of anovulatory infertility and is accompanied by metabolic, psychological, sexual, and quality-of-life disturbances. Pelvic floor dysfunction may represent an under-recognized component of reproductive and sexual health in some affected women. Objective: To evaluate whether structured pelvic floor rehabilitation improves conception and pelvic health outcomes in women with PCOS, infertility, and occult pelvic floor dysfunction. Methods: This parallel-group randomized controlled trial included 72 women allocated equally to an eight-week structured pelvic floor rehabilitation programme or standard care. Rehabilitation comprised supervised pelvic floor muscle training, biofeedback-guided exercises, manual therapy, relaxation training, breathing coordination, and a daily home-exercise programme. Follow-up data were available for 63 participants (intervention n=32; control n=31). Outcomes included conception during follow-up, pelvic floor strength assessed with the Modified Oxford Scale (MOS), sexual function assessed with the Female Sexual Function Index (FSFI), pelvic pain, and quality of life. Results: Conception occurred in 11/32 (34.4%) women in the intervention group and 4/31 (12.9%) controls, corresponding to an absolute risk difference of 21.5 percentage points (95% CI 1.2–41.7; p=0.045) and a crude risk ratio of 2.66 (95% CI 0.95–7.48). Post-intervention MOS scores were 3.4±0.7 versus 2.5±0.6 (mean difference 0.90, 95% CI 0.57–1.23; p<0.001). FSFI scores were higher in the intervention group (24.1±3.8 vs 20.2±3.6; p<0.001), while pain scores were lower (2.1±1.0 vs 3.6±1.2; p<0.001) and quality-of-life scores were higher (78.4±6.5 vs 69.2±7.1; p<0.001). Conclusion: Structured pelvic floor rehabilitation improved pelvic floor strength, sexual function, pain, and quality of life and was associated with a higher observed conception proportion during short-term follow-up. The fertility estimate was imprecise, and larger randomized trials with longer reproductive follow-up and complete randomized-participant analyses are required.
References
1. Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Hum Reprod. 2023;38(9):1655–1679. doi:10.1093/humrep/dead156.
2. Saei Ghare Naz M, Ramezani Tehrani F, Behroozi-Lak T, Mohammadzadeh F, Kholosi Badr F, Ozgoli G. Polycystic ovary syndrome and pelvic floor dysfunction: a narrative review. Res Rep Urol. 2020;12:179–185. doi:10.2147/RRU.S249611.
3. Omar MG, Yousef AM, Kamel HEH, Yosri MM. Prevalence of pelvic floor dysfunction among women with polycystic ovarian syndrome: a case-control study. Bull Fac Phys Ther. 2023;28:9. doi:10.1186/s43161-023-00120-3.
4. Pastoor H, Mousa A, Bolt H, Bramer W, Burgert TS, Dokras A, et al. Sexual function in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2024;30(3):323–340. doi:10.1093/humupd/dmad034.
5. Bachega FS, Turri JA, Baracat MC, Simões R, Maciel GAR, Lobo RA, et al. New comprehension on polycystic ovary syndrome and sexual function: a systematic review and meta-analysis. J Sex Med. 2025. doi:10.1093/jsxmed/qdaf163.
6. Rempert AN, Sarria I, Standeven L, Nylander E, Segars J, Singh B. A systematic review of the psychosocial impact of polycystic ovarian syndrome before and after treatment. Reprod Sci. 2023. doi:10.1007/s43032-023-01285-x.
7. Dybciak P, Raczkiewicz D, Humeniuk E, Powrózek T, Gujski M, Małecka-Massalska T, et al. Depression in polycystic ovary syndrome: a systematic review and meta-analysis. J Clin Med. 2023;12(20):6446. doi:10.3390/jcm12206446.
8. Faucher S, Déry-Rouleau G, Bardin M, Morin M. Investigating the role of the pelvic floor muscles in sexual function and sexual response: a systematic review and meta-analysis. J Sex Med. 2024;21(3):217–239. doi:10.1093/jsxmed/qdad175.
9. Homsi Jorge C, Bø K, Catai CC, Brito LG, Driusso P, Tennfjord M. Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis. Am J Obstet Gynecol. 2024;231(1):51–66.e1. doi:10.1016/j.ajog.2024.01.001.
10. Celenay ST, Karaaslan Y, Ozdemir E. Effects of pelvic floor muscle training on sexual dysfunction, sexual satisfaction of partners, urinary symptoms, and pelvic floor muscle strength in women with overactive bladder: a randomized controlled study. J Sex Med. 2022. doi:10.1016/j.jsxm.2022.07.003.
11. Tracey A. Pelvic floor physical therapy and its merit in the treatment of female urogenital pain. Curr Pain Headache Rep. 2022. doi:10.1007/s11916-022-01076-0.
12. Szafarowska M, Rosiński M, Segiet-Święcicka A, Jędrzejczyk S, Jerzak M, Jerzak MJ. Effect of physiotherapy on infertility treatment in polycystic ovary syndrome patients. Prz Menopauzalny. 2024;23(1):14–20. doi:10.5114/pm.2024.136439.
13. Butt MS, Saleem J, Zakar R, Aiman S, Khan M, Fischer F. Benefits of physical activity on reproductive health functions among polycystic ovarian syndrome women: a systematic review. BMC Public Health. 2023. doi:10.1186/s12889-023-15730-8.
14. Ruiz-González D, Cavero-Redondo I, Hernández-Martínez A, Baena-Raya A, Martínez-Forte S, Altmäe S, et al. Comparative efficacy of exercise, diet and/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis. Hum Reprod Update. 2024. doi:10.1093/humupd/dmae008.
15. Ferreira CHJ, Barbosa PB, Souza FO, Antônio FI, Franco MM, Bø K. Inter-rater reliability study of the modified Oxford Grading Scale and the Peritron manometer. Physiotherapy. 2011;97(2):132–138. doi:10.1016/j.physio.2010.06.007.
16. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208. doi:10.1080/009262300278597.
17. Fernandes ACC, Jorge CH, Weatherall M, Ribeiro IV, Wallace SA, Hay-Smith EJ. Pelvic floor muscle training with feedback or biofeedback for urinary incontinence in women. Cochrane Database Syst Rev. 2025. doi:10.1002/14651858.CD009252.pub2.
18. Frederice C, Mira TAA, Machado H, Brito L, Juliato C. Effect of vaginal stretching and photobiomodulation therapy on sexual function in women with pelvic floor myofascial pain: a randomized clinical trial. J Sex Med. 2022. doi:10.1016/j.jsxm.2021.10.008.
19. Muñoz-Gómez E, Alcaraz-Martínez AM, Mollà-Casanova S, Sempere-Rubio N, Aguilar-Rodríguez M, Serra-Añó P, et al. Effectiveness of a manual therapy protocol in women with pelvic pain due to endometriosis: a randomized clinical trial. J Clin Med. 2023;12(9):3310. doi:10.3390/jcm12093310.
20. Atinga A, Bashiru H, Solomon A, Oghide O, Adufe I, Aduroja P, et al. Depression and anxiety among women with polycystic ovarian syndrome in low- and middle-income countries: a systematic review and meta-analysis. Front Glob Womens Health. 2025. doi:10.3389/fgwh.2025.1688913.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Naheed Shah, Sitara Saif, Huma Gul, Maha Safder, Minahil Adnan, Shabana Khan, Muqaddisa Nawaz (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
© The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
.png)
