Can pelvic floor training help decrease genitourinary symptoms of menopause?

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Can pelvic floor training help decrease genitourinary symptoms of menopause?

Genitourinary syndrome of menopause (GSM) affects up to 50% of postmenopausal women and causes bothersome symptoms such as vaginal dryness, itching sensation, pain with intercourse and urinary incontinence.

As discussed in the article “Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause” pelvic floor muscle exercises can help decrease GSM symptoms. But how come this treatment can lead to those results? It is what I investigated further in my PhD studies.

First, we found that pelvic floor muscle exercises were improving vulvovaginal blood flow. Postmenopausal women experience atrophy of blood vessels located in the vaginal wall, which leads to a reduction of blood flow and vaginal secretions. As studies showed that muscle training increases blood flow in the arteries of trained muscles,[1] our results showed that pelvic floor muscle training also improves blood flow in the surrounding tissues. This result is supported by the significant increase in vaginal secretions, improved color of the vaginal wall, and increased thickness of vaginal mucosa we found during the physical examination. These changes may be related to a reduction in GSM symptoms, such as vaginal dryness and itchiness.

Adapted from the book ‘’L’incontinence urinaire, La prévenir, la traiter’’ with autorisation’’

Second, pelvic floor muscle exercises were shown to improve pelvic floor muscle coordination. As women with vulvovaginal pain,[2] postmenopausal women with GSM are hypothesized to have reduced pelvic floor muscle coordination. After completing the training program including contraction and relaxation exercises, participants had a better capacity to relax their pelvic floor muscles. This new skill can help to reduce vulvovaginal tissue friction and pain during intercourse.

And third, pelvic floor muscle exercises increase vulvovaginal tissue elasticity. Breakdown of collagen and elastin fibers in vulvovaginal tissues occurs with chronic estrogen deprivation in postmenopausal women, leading to loss of vulvovaginal elasticity.[3] Those changes can lead to a narrower and stiffer vaginal opening, which results in pain with intercourse. After the pelvic floor muscle training program, women were showing increased vulvovaginal tissue elasticity as well as a wider vaginal opening. These positive effects could lead to a decreased feeling of vaginal tightness in women with GSM.

Those results helped to understand how a pelvic floor muscle training program can improve GSM symptoms and signs. However, larger studies are needed to confirm those findings.

More details about that study can be found in the article “Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause” published in the Climacteric Journal in 2020.

1. Egginton S. Invited review: activity-induced angiogenesis. Pflugers Arch Eur J Physiol 2009;457:963–77
2. Morin M, Binik YM, Bourbonnais D, Khalife S, Ouellet S, Bergeron S. Heightened pelvic floor muscle tone and altered contractility in women with provoked vestibulodynia. J Sexual Med 2017;14: 592–600
3. Stika CS. Atrophic vaginitis. Dermatol Ther 2010;23:514–22

 

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