Pelvic floor modalities for the management of female sexual dysfunction: a narrative review

OBJECTIVES: Female Sexual Dysfunction (FSD) affects 40%-45% of women globally, with multifactorial causes including pelvic floor dysfunction and hormonal changes. While hormone therapy and psychobehavioral interventions have demonstrated efficacy, they are often limited by side effects, contraindications, variable adherence, and a lack of standardized protocols. Physical therapy (PT) approaches have emerged as promising non-invasive alternatives or adjuncts, targeting underlying neuromuscular, vascular, and structural mechanisms of FSD. This review focuses on PT approaches, evaluating their mechanisms and clinical outcomes to guide evidence-based practice. METHODS: The review followed the PICO framework: Population (women with FSD), Interventions (PT modalities), Comparators (sham/control/alternative treatments), and Outcomes (sexual function scores, pelvic floor muscle parameters, safety). A systematic search was performed in PubMed, Embase, and Web of Science up to April 13, 2025. The search strategy combined relevant MeSH terms and keywords using Boolean operators across three conceptual blocks: including "Sexual Dysfunction, Physiological"[Mesh], "Hypoactive Sexual Desire Disorder", "Orgasmic Disorder" etc., AND "transcutaneous electrical nerve stimulation", "pelvic floor muscle training", "gradual dilation," etc., AND "Women"[Mesh], "Female," "female patient" etc. The full search strategy and screening flowchart is available in Supplementary Material. Inclusion criteria: Randomized controlled trials (RCTs), cohort studies, pilot studies, and case reports were included if they involved women with FSD who received PT interventions and reported outcomes related to sexual function. Exclusion criteria: non-PT interventions, non-FSD populations, and non-English publications. Study selection involved two independent reviewers screening titles/abstracts and full texts. Data on study design, population, intervention, outcomes, and key findings were extracted into standardized tables. RESULTS: Forty-nine clinical studies with 2742 participants were included. Electromagnetic therapy, electrical stimulation, Radiofrequency therapy, pelvic floor muscle training, multimodal pelvic floor physical therapy, vibratory stimulation, dilator therapy, and acupuncture all demonstrated potential efficacy in improving FSD-related symptoms, including sexual function, vaginal laxity, pain, and orgasmic function. CONCLUSIONS: Numerous physical therapy modalities have demonstrated potential efficacy in improving FSD-related symptoms, although evidence quality varies across interventions. Future large-scale RCTs with standardized protocols are needed to confirm long-term benefits and establish optimal treatment algorithms.