Yoga, sexual dysfunction, and female concussions: a mind-body pilot intervention

Sexual wellbeing is a key part of health and should be included in concussion recovery. While yoga can improve concussion outcomes, its effects on sexual wellbeing in women with post-concussion symptoms are unclear. We aimed to evaluate the feasibility (Aim 1) of a brain injury-tailored yoga program, and its impact on sexual function (Aim 2a) and mood correlates-depression, anxiety, PTSD (Aim 2b)-in women aged 18+. We also assessed sustainability (Aim 3) and acceptability/ participant satisfaction with the intervention (Aim 4).

Participants were recruited from PINK Concussions, a social media support network for female concussion patients with symptoms lasting at least 1 month. Twelve participants were enrolled in a 6-week yoga program, and an additional 15 were assigned to a wait-list control condition. Participants received a self-report survey 1-week post- yoga intervention (week 7) and 5 weeks post-intervention (week 11). All participants were yoga novices, defined as practicing yoga once a month or less. Sessions were held over Zoom and led by a certified yoga instructor. The Female Sexual Functioning Index-6 (FSFI-6) was used to assess sexual dysfunction. Participants also completed measures of depression (PHQ-9), anxiety (GAD-7), and PTSD (PCL-5). We used difference in differences estimates to calculate the average treatment effects, and the counterfactual means of the intervention group. We also used Glass' Delta (Δ) to calculate effect sizes.

(Aim 1) Fifty-seven eligible women expressed interest in the yoga program. Invitations were sent in two batches to limit sessions to 15 participants. For Group 1 (Yoga group), 27 women were invited; 16 (59%) confirmed interest, and 12 enrolled after exclusions due to scheduling constraints. Attendance varied, with 6/12 (50%) completing ≥3 sessions; 5 of these 6 (83%) completed both week-7 and week-11 follow-up surveys. For Group 2 (wait-list controls), 34 women were invited, including those unable to attend Group 1. 15 (44%) confirmed participation, and 11 (73%) completed both follow-up surveys. Outcomes were compared between the yoga and wait-list control groups. At 1-week post-yoga intervention (Aims 2a and 2b), participants reported substantial improvements in their sexual functioning and mood symptoms. Effect sizes: large for sexual function (Δ = -0.50), medium for anxiety (-0.30), small for PTSD (-0.15) and depression (0.05). At 5 weeks (Aim 3), scores declined slightly but stayed above baseline. Sexual function retained a medium effect size (-0.34). All other domains had small effect sizes. Acceptability was high, with mean satisfaction scores of 8.7/10 (Aim 4). Using open-ended text boxes, participants commented on the intervention's impact on their mental health, physicality, social connection/isolation/belonging; and provided suggestions for improvement.

Yoga has the potential to improve women's sexual functioning after concussion and offers a non-pharmacological alternative for treating mood and other important correlates of women's sexual well-being. Larger randomized trials are needed.