Female Sexual Function and Pelvic Floor Muscle Training: A Narrative Review

Female sexual dysfunction (FSD) is a multifactorial condition affecting desire, arousal, orgasm, and satisfaction, with wide-ranging implications for women's physical and emotional well-being. Although prevalent, especially among postmenopausal and postpartum populations, FSD remains under-recognized and undertreated. Pelvic floor muscle training (PFMT) has emerged as a promising, non-invasive therapeutic approach for managing FSD, particularly when associated with pelvic floor disorders such as urinary incontinence, pelvic organ prolapse, and overactive bladder. This narrative review synthesizes anatomical, physiological, clinical, and therapeutic insights into the relationship between pelvic floor function and female sexual health. The pelvic floor's structural complexity-comprising muscular, connective, and neurovascular elements-plays a crucial role in sexual response. Dysfunction of this system can contribute to sexual pain, reduced arousal, and orgasmic disorders. PFMT, involving voluntary muscle contractions, biofeedback, or electrical stimulation, has demonstrated benefits across diverse female populations. Variables such as frequency, intensity, supervision, and duration of PFMT significantly influence its effectiveness. Evidence suggests that PFMT improves sexual function in general populations and is particularly beneficial for postpartum, postmenopausal women, and those with neurological or gynecological issues. Improvements are seen in sexual desire, arousal, lubrication, orgasm, and pain reduction. The mechanisms underlying these effects include enhanced muscle strength, increased genital blood flow, and psychological improvements such as body awareness and reduced anxiety. Despite strong supportive evidence, implementation challenges persist, including adherence difficulties, a lack of standardized protocols, and insufficient professional training. Barriers to adherence include misconceptions, discomfort, lack of motivation, and poor understanding of proper technique. Facilitators include clear guidance, customized approaches, technological tools, and professional supervision. Mobile health applications and patient empowerment strategies show promise in enhancing engagement and outcomes. Future research should focus on long-term efficacy, standard intervention protocols, and the integration of PFMT with other therapies, such as pharmacological treatments. Overall, PFMT represents a low-risk, cost-effective intervention capable of significantly improving quality of life and sexual function in women across the lifespan.