The Connection Between HRT and Pelvic Floor Muscles in Treating Female Sexual Dysfunction

Pelvic floor muscles (PFM) have a distinct connection to female sexual dysfunction (FSD). Because PFMs surround the female reproductive organs, they play a large part in FSD like dyspareunia, vulvodynia, vestibulodynia, and more. Weak PFMs may lead to a feeling of looseness in the vagina and may contribute toward pelvic organ prolapse (POP), where the pelvic organs begin to fall out through the vagina. Additionally, PFMs being too strong or tight may contribute toward pelvic and vaginal pain disorders.

Research has surfaced within the past decade that hormones influence PFM function, and hormone replacement therapy (HRT) can be used to treat various pelvic floor disorders. This article aims to elaborate on PFM therapy and the connection between PFM, HRT, and FSD.

Pelvic Floor Muscle Therapy

PFM therapy is used very commonly in clinical settings to help mitigate many effects of FSD and other pelvic floor disorders. These techniques work to strengthen the PFM tone, otherwise known as how tight the muscles are at a resting state. Usually, a patient will be asked to lie in the supine position with knees bent at a specific angle, squeezing and holding and then releasing the PFMs in a specific pattern. PFM has been proven useful in cases of chronic pelvic pain and POP, or any case of bowel or bladder incontinence. PFM therapy can help mitigate muscle spasms, and improve contractions and relaxation during sexual activity, leading to a more enjoyable experience for those with FSD.

Hormone Replacement Therapy

HRT involves replacing hormones that have declined in the body. This may be during menopause, or as a part of gender-affirming care. This is especially helpful with sexual function, as many gynecological processes may be interrupted in post-menopausal women. Issues like vaginal dryness, vaginismus, lack of libido, and more may be afflicting these patients. HRT may include estrogen, progestin, or testosterone supplements in a variety of mediums that can help supplement this hormonal imbalance.

How HRT helps with PFM

Conflicting information continues to circulate about whether or not HRT helps or hinders PFM function. However, there is a connection between hormonal changes and PFM function. While pregnancy does play a role in changing PFM tone, postmenopausal women are also afflicted by pelvic floor disorders and FSD related to the PFMs. In fact, HRT has been used to treat pelvic floor disorders such as overactive bladder syndrome with success, as well as recurring urinary tract infections, and POP. Additionally, using PFM therapy alongside HRT may be especially useful for women experiencing FSD. Unfortunately, more information and research is need to make a solid conclusion as to the usefulness of HRT in use with PFM therapy.

Key Points

• PFM therapy and HRT are both great options for post-menopausal women, and those with PFM-related FSD.
• This should be something patients want to do enthusiastically, as not everyone agrees that either of these conditions are distressing to them.
• Clinicians should keep in mind that these therapies take time and may require adjustments over time. If HRT is simply not working for a patient, discuss options with the patient before prescribing a different type of therapy.

Resources:

Bodner-Adler, B., Alarab, M., Ruiz-Zapata, A. M., & Latthe, P. (2019). Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association Research and Development—Committee opinion. International Urogynecology Journal, 31(8), 1577–1582. https://doi.org/10.1007/s00192-019-04070-0

Faucher, S., Déry-Rouleau, G., Bardin, M., & Morin, M. (2024). Investigating the role of the pelvic floor muscles in sexual function and sexual response: A systematic review and meta-analysis. The Journal of Sexual Medicine, 21(3), 217–239. https://doi.org/10.1093/jsxmed/qdad175

Grimes, W. R. (2023, June 26). Pelvic floor dysfunction. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK559246/

Zhuo, Z., Wang, C., Yu, H., & Li, J. (2021). The relationship between pelvic floor function and sexual function in perimenopausal women. Sexual Medicine, 9(6), 100441–100441. https://doi.org/10.1016/j.esxm.2021.100441