The Effectiveness of a Combined Pelvic Floor Exercise Program and Desensitization-Based Sex Therapy on Pain and Sexual Satisfaction in Female Athletes

Abstract

Objective: This study evaluated the effectiveness of an integrated pelvic floor muscle training program combined with desensitization-based sex therapy on sexual pain and sexual satisfaction in female athletes.

Methods: In a randomized controlled trial, 68 sexually active female athletes (18–40 years) reporting penetration-related pain were allocated to either a combined intervention group (PFMT plus desensitization-based sex therapy; 8 weekly sessions) or an attention-matched education control group. Outcomes were assessed at baseline, post-intervention (8 weeks), and 3-month follow-up. Primary outcomes included pain during intercourse (Visual Analogue Scale, VAS) and sexual satisfaction (Female Sexual Function Index, FSFI). Secondary outcomes included sexual distress, pain catastrophizing, and pelvic floor muscle strength. Data were analyzed using intention-to-treat mixed-effects models.

Results: At post-intervention, the combined intervention group demonstrated significantly greater reductions in sexual pain compared with controls (adjusted mean difference = −1.0, 95% CI −1.6 to −0.4; p = .001; Cohen’s d = 0.60). Sexual satisfaction improved significantly in the intervention group (adjusted difference = +3.1 FSFI points, 95% CI 1.4–4.8; p < .001; d = 0.65). Improvements were largely maintained at 3-month follow-up. Significant reductions were also observed in pain catastrophizing (d = 0.70) and sexual distress (d = 0.72), alongside objective gains in pelvic floor muscle strength (p < .001).

Conclusion: A combined PFMT and desensitization-based sex therapy program is an effective, non-invasive intervention for reducing sexual pain and improving sexual satisfaction in female athletes, supporting a biopsychosocial approach to sexual rehabilitation in sports contexts.