Physiotherapy improves sexual health of women with SSc: Study

None of the program participants reported a decline in sexual function in FSFI score

Andrea Lobo, PhD avatar

by Andrea Lobo, PhD |

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A woman lies on a table during a session with a physical therapist.

A physiotherapy program improved sexual function and quality of life, while also preventing the deterioration in functional ability in women with systemic sclerosis (SSc), a study in the Czech Republic reports.

The eight-week program consisted of a one-hour session, twice weekly, of targeted physiotherapy according to the patients’ needs.

“Further validation of our pilot results could introduce a potential therapeutic modality for managing these conditions and provide patients the opportunity to actively participate in their treatment,” the researchers wrote in “Effect of an 8-Week Tailored Physiotherapy Program on Sexual Health in Women with Scleroderma and Myositis: A Controlled Pilot Study,” which was published in Rheumatology and Therapy.

SSc is a chronic autoimmune disease, wherein the immune system attacks tissues, resulting in excessive inflammation that affects the skin and connective tissue, which supports and holds organs together.

SSc symptoms often lead to significant disability and reduced quality of life, including lower sexual function in women. One of the factors that might be associated with women’s sexual impairments is pelvic floor dysfunction, or the inability to properly relax and coordinate the pelvic floor muscles that support the bowel and bladder as well as the uterus and vagina.

Physical activity has been shown to improve muscle strength and function. In the general population, exercise can improve women’s sexual health.

To see if targeted physiotherapy could improve sexual function in women with SSc, researchers at the Institute of Rheumatology, Prague recruited patients to an eight-week program that targeted musculoskeletal problems (which affect the locomotor system — muscles, bones, joints, and connective tissue) and pelvic floor exercises. A control group didn’t receive specialized therapy for sexual dysfunction.

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Physiotherapy’s effects on sexual function

Before and after the program, the patients responded to questions that helped assess their sexual function — including the Female Sexual Function Index (FSFI) and the Brief Index of Sexual Functioning for Women (BISF-W) — functional ability, quality of life, and depression.

Fourteen women with SSc participated in the study. Based on their capability and motivation, they were assigned to the physiotherapy program or the control group. Each group had seven participants with SSc.

The final analysis included six people with SSc from each group. Two women with idiopathic inflammatory myopathies (IMM) were also included in each group. IMM is a group of disorders marked by inflammation of muscles used in movement.

The group assigned to the exercise program had the same number of women with limited or diffuse cutaneous SSc. In the control group, most patients had diffuse SSc. The scientists said that could explain the higher disease activity, skin thickness score, inflammation, functional limitations, and lower quality of life in the physical component in the control group.

Patients in the physiotherapy group considered sex an important part of their lives; those in the control group didn’t.

Sexual function was comparable at baseline. During the program, FSFI scores showed a trend toward improvement in sexual function among the women from the physiotherapy program over the controls.

Specifically, there was a clinically meaningful improvement (20% or more) in the FSFI total score for 25% of the women in the physiotherapy group compared to 12.5% among the controls. Also, 37.5% of controls reported a clinically meaningful deterioration in sexual function (of 20% or more), versus none in the physiotherapy group.

Changes included arousal, lubrication, and sexual pain domains of FSFI, although only those in arousal were statistically different. No differences were observed regarding sexual desire, orgasm, and sexual satisfaction.

Similar results were obtained with the BISF-W total score, with 62.5% of women in the physiotherapy group reporting a clinically meaningful improvement, versus 12.5% of controls. Half the controls reported a clinically meaningful deterioration of sexual function versus 12.5% in the physiotherapy group.

A trend toward being more sexually active

Women in the physiotherapy group showed a trend toward being more sexually active during the program, compared to controls, who remained unchanged or were slightly less sexually active. The two groups also differed regarding changes in the frequency of sexual activity or receptivity toward sex, which increased in the physiotherapy group. For the women who had physiotherapy, a significant improvement was also seen in quality of life, whereas no changes were observed in the control group.

“Our eight-week physiotherapy program not only prevented the natural course of progressive deterioration of functional ability but also led to a significant improvement in sexual function and quality of life in women with SSc,” the researchers wrote.