Effectiveness of Pelvic Floor Physiotherapy in Management of Sexual Dysfunction After Childbirth — Systematic Review

Abstract

Background: Sexual dysfunction is common after childbirth and may be related to pelvic floor muscle (PFM) weakness, perineal trauma, pain, and psychosocial factors. Pelvic floor physiotherapy (PFPT) — especially pelvic floor muscle training (PFMT), manual therapy, biofeedback, electrostimulation, and myofascial trigger-point release — is widely used to address postpartum pelvic problems, but evidence for improving sexual function after childbirth is mixed.

Objective: To systematically review randomized and controlled studies that evaluate the effectiveness of pelvic floor physiotherapy on sexual function in women after childbirth.

Methods: PRISMA 2020 methodology was followed. We searched PubMed/MEDLINE, Embase/Scopus, Cochrane CENTRAL, PEDro and Google Scholar through October 5, 2025 for RCTs, controlled clinical trials, and high-quality quasi-experimental studies. Inclusion: women postpartum (any parity), PFPT interventions (PFMT, biofeedback, manual therapy, electrical stimulation, trigger-point release), sexual-function outcomes (Female Sexual Function Index [FSFI] or domain scores, pain with intercourse, sexual satisfaction), and comparator groups (no intervention, sham, or usual care). Risk of bias was assessed with RoB-2 for RCTs and ROBINS-I for nonrandomized studies. Due to heterogeneity, a narrative synthesis plus study-level summary tables is presented.

Results: (Summary of available evidence) Multiple randomized and controlled trials and several systematic reviews/meta-analyses report modest improvements in global sexual function (FSFI total score) and some FSFI domains (desire, arousal, lubrication, orgasm) following PFMT versus no intervention; however, effect sizes vary, and overall certainty is low-to-moderate because of heterogeneity in interventions, timing postpartum, small sample sizes, and risk-of-bias concerns. Some larger contemporary systematic reviews and meta-analyses (2023–2024) conclude PFMT improves FSFI total and several domains but call for more high-quality RCTs. Individual RCTs show mixed results (some positive, some null). Interventions such as pelvic myofascial trigger-point release have recent promising RCT data but require replication. Adverse events were infrequent and minor.

Conclusions: Pelvic floor physiotherapy (especially supervised PFMT) appears to improve postpartum sexual function in many studies, but the evidence strength is limited by study heterogeneity and methodological issues. Clinicians may reasonably offer PFPT for postpartum sexual problems while counselling patients about variable benefit; further large, -

well-designed RCTs using standardized PFPT protocols and standardized sexual-function outcomes are needed