Effectiveness of Physical Therapy in Addressing Sexual Dysfunction in Individuals with Multiple Sclerosis: A Systematic Review and Meta-analysis

Background Individuals with multiple sclerosis (MS) frequently report sexual dysfunction, a condition that may result in low sexual satisfaction and decreased quality of life. Although sexual dysfunction is usually treated pharmacologically, physical therapists, especially those trained in pelvic floor physical therapy (PT), are well-equipped to address a variety of impairments that contribute to poor sexual function. The current evidence for effectiveness of PT interventions in improving sexual dysfunction, sexual satisfaction, and the emotional well-being aspect of quality of life was analyzed. Methods The PubMed, CINAHL, and PEDro databases were searched through December 2019. Articles were included if participants had a clinical diagnosis of MS, reported sexual dysfunction or pain with intercourse, and had an intervention within the PT scope that addressed sexual dysfunction. Means and SDs were extracted from each study independently by two authors. Effect sizes (d) and 95% CIs were calculated within and across studies. Results Eight studies met the inclusion criteria. Combined effects were significant and large across six studies for sexual function (d = 0.82, 95% CI, 0.57-1.06), moderate across seven studies for sexual satisfaction (d = 0.65, 95% CI, 0.43-0.87), and moderately large across two studies for emotional well-being (d = 0.78, 95% CI, 0.17-1.40). Between-group differences reached significance for sexual satisfaction (d = 0.29, 95% CI, 0.03-0.55). Conclusions Sexual function, sexual satisfaction, and emotional well-being can all be effectively addressed with various PT interventions. Highly effective interventions included pelvic floor muscle training and mindfulness. Future research should compare PT interventions with non-PT controls to determine best practice in this population.