Relationship between pelvic floor muscle strength and sexual dysfunction in postmenopausal women: a cross-sectional study
Abstract
Introduction and hypothesis The prevalence of sexual dysfunction in postmenopausal women is high. Theoretically pelvic floor muscle (PFM) strength could influence sexual function, but to date there is scant evidence on this topic. The aim of this study was to evaluate the relationship between PFM strength and sexual function in postmenopausal women. The relationship between reported urinary incontinence (UI) and sexual dysfunction was also investigated.Methods This was a cross-sectional study including 113 postmenopausal women. PFM strength was evaluated using vaginal manometry. Sexual function was evaluated using the Female Sexual Function Index (FSFI). A score of ≤26.5 was considered to indicate sexual dysfunction. Urinary incontinence reports were evaluated using the International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) Short Form. Statistical analysis was performed using Spearman's rank correlation coefficient (ρ), the Mann-Whitney test and 95 % confidence intervals.Results The median age of the women was 53 years (range 42 - 65 years) and their median body mass index was 27.9 kg/m 2 (range 20 - 42 kg/m 2). Women without sexual dysfunction showed significantly higher PFM strength (median 41.8, range 11.3 - 94.0 cmH 2 O) than women with sexual dysfunction (median 30.3, range 3 - 112 cmH 2 O; p = 0.02). A weak correlation was found between the total FSFI score and the total ICIQ-UI score (ρ = -0.21, p = 0.03).Conclusions Postmenopausal women with sexual dysfunction showed lower PFM strength than women without sexual dysfunction. There was a weak correlation between urinary incontinence severity and sexual function.
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Cites
Statistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,588 · see citing works
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,406 · see citing works
Rosen, C. B. (2000) · Journal of Sex & Marital Therapy · doi:10.1080/009262300278597 · Cited by 6,593 · see citing works
The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores
WIEGEL, M., MESTON, C., & ROSEN, R. (2005) · Journal of Sex & Marital Therapy · doi:10.1080/00926230590475206 · Cited by 2,396 · see citing works
ICIQ: A brief and robust measure for evaluating the symptoms and impact of urinary incontinence
AVERY, K. N. L., Donovan, J., Peters, T. J., Shaw, C., Gotoh, M., & Abrams, P. (2004) · Neurourology and Urodynamics · doi:10.1002/nau.20041 · Cited by 1,995 · see citing works
Evaluation of Female Pelvic-Floor Muscle Function and Strength
Bø, K., & Sherburn, M. (2005) · Physical Therapy · doi:10.1093/ptj/85.3.269 · Cited by 612 · see citing works
Self-citationTamanini, J. T. N., Dambros, M., D’Ancona, C. A. L., Palma, P. C. R., & Netto, N. R. (2004) · Revista de Saúde Pública · doi:10.1590/s0034-89102004000300015 · Cited by 428 · see citing works
Salonia, A., Zanni, G. E., Nappi, R. E., Briganti, A., Dehò, F., Fabbri, F., Colombo, R., Guazzoni, G. F., Girolamo, V. D., Rigatti, P., et al. (2003) · European Urology · doi:10.1016/j.eururo.2003.11.023 · Cited by 371 · see citing works
Klovning, A., AVERY, K. N. L., Sandvik, H., & Hunskaar, S. (2009) · Neurourology and Urodynamics · doi:10.1002/nau.20674 · Cited by 371 · see citing works
Sexual function among women with urinary incontinence and pelvic organ prolapse
Handa, V. L., HARVEY, L. A., Cundiff, G. W., Siddique, S. A., & Kjerulff, K. H. (2004) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2003.11.017 · Cited by 251 · see citing works
The Menopause and Sexual Functioning: A Review of the Population-Based Studies
Dennerstein, L., Alexander, J. L., & Kotz, K. (2003) · Annual Review of Sex Research · doi:10.1080/10532528.2003.10559811 · Cited by 238 · see citing works
The Role of the Levator Ani Muscle in Evacuation, Sexual Performance and Pelvic Floor Disorders
Shafik, A. (2000) · International Urogynecology Journal · doi:10.1007/pl00004028 · Cited by 159 · see citing works
Gerstenberger, E. P., Rosen, R. C., Brewer, J. V., Meston, C. M., Brotto, L. A., Wiegel, M., & Sand, M. S. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2010.01871.x · Cited by 158 · see citing works
Female Sexual Dysfunction: Prevalence and Risk Factors
Jeihooni, A. K. (2013) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr/2013/6813.3822 · Cited by 156 · see citing works
Sexual functions of the pubococcygeus muscle.
Kegel, A. H. (1952) · PubMed · Cited by 129 · see citing works
Validade de construto de uma versão em português do Female Sexual Function Index
Pacagnella, R. D. C., Martínez, E. Z., & Vieira, E. M. (2009) · Cadernos de Saúde Pública · doi:10.1590/s0102-311x2009001100004 · Cited by 117 · see citing works
Can stronger pelvic muscle floor improve sexual function?
Löwenstein, L., Gruenwald, I., Gartman, I., & Vardi, Y. (2010) · International Urogynecology Journal · doi:10.1007/s00192-009-1077-5 · Cited by 111 · see citing works
Does pelvic floor muscle training improve female sexual function? A systematic review
Ferreira, C. H. J., Dwyer, P. L., Davidson, M., De Souza, A., Ugarte, J. A., & Frawley, H. C. (2015) · International Urogynecology Journal · doi:10.1007/s00192-015-2749-y · Cited by 106 · see citing works
Self-citationWomen with greater pelvic floor muscle strength have better sexual function
Martinez, C. S., Ferreira, F. V., de Castro, A. A. M., & Gomide, L. B. (2014) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.12379 · Cited by 95 · see citing works
Mode of delivery and pelvic floor muscle strength and sexual function after childbirth
BAYTUR, Y. B., Deveci, A., Uyar, Y., Ozcakir, H. T., Kızılkaya, S. U., & Çağlar, H. (2005) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2004.12.019 · Cited by 91 · see citing works
for the Society of Gynecologic Surgeons Systematic Review Group, Rahn, D. D., Ward, R. M., Sanses, T. V. D., Carberry, C. L., Mamik, M. M., Meriwether, K. V., Olivera, C. K., Abed, H., Balk, E. M., et al. (2014) · International Urogynecology Journal · doi:10.1007/s00192-014-2554-z · Cited by 88 · see citing works
Female orgasm: role of pubococcygeus muscle.
Graber, B., & Kline‐Graber, G. (1979) · PubMed · Cited by 83 · see citing works
Brækken, I. H., Majida, M., Ellström Engh, M., & Bø, K. (2015) · The Journal of Sexual Medicine · doi:10.1111/jsm.12746 · Cited by 75 · see citing works
Self-citationReliability of pelvic floor muscle strength measurement in elderly incontinent women
Kerschan‐Schindl, K., Uher, E. M., Wiesinger, G., Kaider, A., EBENBICHLER, G. R., Nicolakis, P., Kollmitzer, J., Preisinger, E., & Fialka‐Moser, V. (2001) · Neurourology and Urodynamics · doi:10.1002/nau.2099 · Cited by 68 · see citing works
Sexual dysfunction among married couples living in Kumasi metropolis, Ghana
Amidu, N., Owiredu, W. K., Gyasi-Sarpong, C. K., Woode, E., & Quaye, L. (2011) · BMC Urology · doi:10.1186/1471-2490-11-3 · Cited by 58 · see citing works
Body mass index, urinary incontinence, and female sexual dysfunction
Pace, G., Silvestri, V., Gualà, L., & Vicentini, C. (2009) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3181a6b491 · Cited by 48 · see citing works
Clayton, A. H., Dennerstein, L., Fisher, W. A., Kingsberg, S. A., Perelman, M. A., & Pyke, R. E. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2009.01628.x · Cited by 47 · see citing works
Dyspareunia is associated with decreased frequency of intercourse in the menopausal transition
Thomas, H. M., Bryce, C. L., Ness, R. B., & Hess, R. (2011) · Menopause · doi:10.1097/gme.0b013e3181eeb774 · Cited by 37 · see citing works
Sexuality during the climacteric period
Lara, L. A. D. S., Useche, B., Silva, J. C. R. E., Ferriani, R. A., dos Reis, R. M., de Sá, M. F. S., de Carvalho, B. R., Carvalho, M. Â. C. R., & Silva, A. C. J. D. S. R. E. (2009) · Maturitas · doi:10.1016/j.maturitas.2008.12.014 · Cited by 34 · see citing works
Sexual dysfunction among postmenopausal women.
Masliza, W. D. W., Daud, W. R. W., Bajuri, M. Y., Shuhaila, A., Hatta, S., Hassan, M. R., & Mn, N. (2014) · PubMed · doi:10.7471/ct.2014.1681 · Cited by 31 · see citing works
Sexual Function Before and After Nonsurgical Treatment of Stress Urinary Incontinence
Handa, V. L., Whitcomb, E. L., Weidner, A. C., Nygaard, I., Brubaker, L. T., Bradley, C. S., Paraiso, M. F. R., Schaffer, J. I., Zyczynski, H. M., Zhang, M., et al. (2011) · Urogynecology · doi:10.1097/spv.0b013e318205e263 · Cited by 29 · see citing works
Pelvic Floor Muscle Training for Urinary Incontinence
Betschart, C., Mol, S. E., Lütolf-Keller, B., Fink, D. A., Perucchini, D., & Scheiner, D. (2013) · Urogynecology · doi:10.1097/spv.0b013e31829950e5 · Cited by 20 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Ferreira, C. H. J., Bø, K., Catai, C. C., Brito, L. G. O., Driusso, P., & Tennfjord, M. K. (2024) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2024.01.001 · Cited by 97 · see citing works
Self-citationFranco, M. M., Pena, C. C., de Freitas, L. M., Antônio, F. I., Lara, L. A. D. S., & Ferreira, C. H. J. (2021) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2021.05.005 · Cited by 74 · see citing works
Self-citationAndrade, R., Bø, K., Antônio, F. I., Driusso, P., Mateus-Vasconcelos, E. C. L., Ramos, S. B., Julio, M. P., & Ferreira, C. H. J. (2018) · Journal of physiotherapy · doi:10.1016/j.jphys.2018.02.010 · Cited by 66 · see citing works
Self-citationBø, K., Anglès-Acedo, S., Batra, A., Brækken, I. H., Chan, Y. L., Jorge, C. H., Kruger, J., Yadav, M., & Dumoulin, C. (2022) · International Urogynecology Journal · doi:10.1007/s00192-022-05324-0 · Cited by 64 · see citing works
“There is some evidence that women without sexual dysfunction have increased PFM strength compared to women with sexual dysfunction [87].”
BackgroundSelf-citationNazarpour, S., Simbar, M., Majd, H. A., & Tehrani, F. R. (2018) · Sexual Health · doi:10.1071/sh17203 · Cited by 54 · see citing works
Vieira, G. F., Saltiel, F., Miranda-Gazzola, A. P. G., Kirkwood, R. N., & Figueiredo, E. M. (2019) · Physiotherapy · doi:10.1016/j.physio.2019.12.006 · Cited by 50 · see citing works
Dorner, T. E., Berner, C., Haider, S., Grabovac, I., Lamprecht, T., Fenzl, K. H., & Erlacher, L. (2018) · Rheumatology International · doi:10.1007/s00296-018-4023-3 · Cited by 39 · see citing works
Pasqualotto, L. T., Riccetto, C., Biella, A. F. D. C. L., Marques, J., Pereira, L. C., Alves, F., Lunardi, A. L. B., Adami, D. B. V., Nagib, A. B. L., Martinho, N., et al. (2022) · International Urogynecology Journal · doi:10.1007/s00192-021-05032-1 · Cited by 33 · see citing works
Pelvic floor muscle strength is correlated with sexual function
Sartori, D. V. B., Kawano, P. R., Yamamoto, H., Guerra, R., Pajolli, P., & Amaro, J. L. (2020) · Korean journal of urology · doi:10.4111/icu.20190248 · Cited by 32 · see citing works
Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women
Omodei, M. S., Delmanto, L. R. M. G., Pessoa, E. C., Schmitt, E. B., Nahas, G. P., & Nahás, E. A. P. (2019) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2019.09.014 · Cited by 30 · see citing works
Khosravi, A., Riazi, H., Simbar, M., & Montazeri, A. (2022) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2022.05.022 · Cited by 25 · see citing works
García‐Mejido, J. A., Valero, I., Gálvez, I. M. A., Borrero, C., Fernández-Palacín, A., & Sainz‐Bueno, J. A. (2020) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.13852 · Cited by 18 · see citing works
Hwang, U., Lee, M. S., Jung, S., Ahn, S. H., & Kwon, O.-Y. (2021) · Sexual Medicine · doi:10.1016/j.esxm.2021.100325 · Cited by 17 · see citing works
The Effect of Aging on Pelvic Floor Pressure Measurements in Nulliparous Women
Alshiek, J. A., Wei, Q., Jalalizadeh, M., Chitnis, P. V., & Shobeiri, S. A. (2020) · Open Journal of Obstetrics and Gynecology · doi:10.4236/ojog.2020.1060070 · Cited by 12 · see citing works
Status of female sexual dysfunction among postmenopausal women in Bangladesh
Amin, M. A., Mozid, N.-E., Ahmed, S. B., Sharmin, S., Monju, I. H., Jhumur, S. S., Sarker, W., Dalal, K., & Hawlader, M. D. H. (2022) · BMC Women s Health · doi:10.1186/s12905-022-01991-9 · Cited by 12 · see citing works
dos Santos, M. D., Palmezoni, V. P., Torelli, L., Baldon, V. S. P., Sartori, M. G. F., & Resende, A. P. M. (2017) · Neurourology and Urodynamics · doi:10.1002/nau.23353 · Cited by 11 · see citing works
Gao, L., Xie, B., Zhu, H., Zhang, D., Fu, X., Li, H., Zhen, M., Qin, B., Chen, W., Mao, X., et al. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1093830 · Cited by 10 · see citing works
Female Sexual Function and Pelvic Floor Muscle Training: A Narrative Review
Stamos, D., Sapouna, V., Astraka, K. M., Thanopoulou, S., Giannakis, I., Pantou, A., Baltogiannis, D., Paschopoulos, M. E., Sofikitis, N., & Zachariou, A. (2025) · Cureus · doi:10.7759/cureus.85751 · Cited by 8 · see citing works
Alshiek, J. A., Wei, Q., & Shobeiri, S. A. (2022) · International Urogynecology Journal · doi:10.1007/s00192-022-05117-5 · Cited by 8 · see citing works
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Siregar, M. F. G., Azmeila, S., Sitompul, A., & Siregar, M. E. A. G. (2021) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2021.6345 · Cited by 8 · see citing works
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Somavilla, P., Pasqualoto, A. S., & Braz, M. M. (2022) · Fisioterapia em Movimento · doi:10.1590/fm.2022.356011 · Cited by 5 · see citing works
Duarte, N. D. S., Bittencourt, K. C., Soares, C. O., Ferreira, C. R. G., Soares, W. M., Tavares, V. B., da Silva, A. S. A., Priante, C. H. D. C., das Neves, P. F. M., Souza, G. D. S., et al. (2022) · Healthcare · doi:10.3390/healthcare11010129 · Cited by 5 · see citing works
Self-citationWalgren, L., Wade, C. E., Dessaulles, M., Ginis, K. A. M., & Locke, J. A. (2024) · Post Reproductive Health · doi:10.1177/20533691241272830 · Cited by 4 · see citing works
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Colombage, U. N., Soh, S., Lin, K.-Y., & Frawley, H. (2023) · Continence · doi:10.1016/j.cont.2023.100580 · Cited by 4 · see citing works
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de Freitas, C. S., Pivetta, H. M. F., Vey, A. P. Z., Sperandio, F. F., Braz, M. M., & Mazo, G. Z. (2020) · Fisioterapia em Movimento · doi:10.1590/1980-5918.033.ao23 · Cited by 3 · see citing works
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Bjorn, B. A. (2023) · Journal of Counseling Sexology and Sexual Wellness · doi:10.34296/04s11076 · Cited by 2 · see citing works
Tekbaş, S. (2025) · Medicine · doi:10.1097/md.0000000000044324 · Cited by 1 · see citing works
Ferreira, L. A., Fitz, F. F., Cruz, M., Giménez, M. L., Matias, M., Bortolini, M. A. T., & Castro, R. A. (2025) · International Urogynecology Journal · doi:10.1007/s00192-025-06352-2 · Cited by 1 · see citing works
Lucena, S. V. (2018) · Journal of Gynecology and Obstetrics · doi:10.11648/j.jgo.20180605.11 · Cited by 1 · see citing works
da Silva, J. B., Szkudlarek, A. C., Valadão, A. P. M., Gallo, R. B. S., & Korelo, R. I. G. (2023) · Revista Brasileira de Ciência e Movimento · doi:10.31501/rbcm.v30i2.13187 · Cited by 1 · see citing works
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Prakashini, M. V. (2023) · Anti-Aging Eastern Europe · doi:10.56543/aaeeu.2023.2.1.03 · Cited by 1 · see citing works
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do Amaral, M. T. P., Scudeller, T. T., dos Santos, M. C. F., Guidorzi, N. V., & Zanetti, M. R. D. (2020) · ABCS Health Sciences · doi:10.7322/abcshs.45.2020.1263 · Cited by 1 · see citing works
Lindgren, A. (2020) · Linköping University medical dissertations · doi:10.3384/diss.diva-170070 · Cited by 1 · see citing works
Sintomas geniturinários em mulheres com câncer de mama em tratamento quimioterápico
Tomadon, A. (2020) · doi:10.11606/t.22.2020.tde-06072020-154500 · Cited by 1 · see citing works
Montoya, J. E. F. (2017) · Revista Urología Colombiana / Colombian Urology Journal · doi:10.1016/j.uroco.2017.05.003
Evaluating Affecting Factors on Sexual Function of Menopausal Women
Bayat, Z., Youseflu, S., Afrashteh, M. Y., & Niroomand, S. (2021) · Preventive Care In Nursing and Midwifery Journal · doi:10.52547/pcnm.11.1.56
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Calças, M. A. D. P., do Prado, L. M., Ribeiro-Silva, V. H. A., Franco, L., do Prado, L. G. C., Gallo, G., Mélo, A. M., Melchior, M. D. O., Lara, L. A. D. S., Leite‐Panissi, C. R. A., et al. (2026) · CRANIO® · doi:10.1080/08869634.2026.2737379
- Authors
- de Menezes Franco, M., Driusso, P., Bø, K., Carvalho de Abreu, D. C., da Silva Lara, L. A., de Sá Rosa e Silva, A. C. J., & Ferreira, C. H. J.
- Affiliations
- Norwegian School of Sport Sciences (NO)
- Universidade de São Paulo (BR)
- Corresponding author
- Ferreira, Cristine Homsi Jorge
- Venue
- International Urogynecology Journal
- Published
- 2016-12-06
- Volume
- 28
- Issue
- 6
- Pages
- 931-936
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- OpenAlex
- W2560835229
- Cited by
- 41
- References
- 32
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 5 · 2022: 8 · 2021: 4 · 2020: 8 · 2019: 2 · 2018: 4 · 2017: 3
- FWCI
- 2.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Urogynecology Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fundação de Amparo à Pesquisa do Estado de São Paulo (- 2012/215239)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Keywords
- pelvic floor muscle strength, sexual dysfunction, postmenopausal women, urinary incontinence, Female Sexual Function Index, female sexual function
- MeSH terms
- Adult, Aged, Cross-Sectional Studies, Female, Humans, Manometry, Middle Aged, Sexual Dysfunction, Physiological, Urinary Incontinence, Vagina, Postmenopause, Pelvic Floor, Muscle Strength
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