Can the positive results of pelvic floor muscle training on vaginal dryness be explained?

There are promising signs that pelvic floor muscle training has a positive effect on vaginal dryness and dyspareunia in women with genitourinary syndrome. This was one of the results of the feasibility study I discussed in my previous blog. Objectively, an increase in secretions and color of the vaginal wall and thicker vaginal epithelial surface was observed. Today I will discuss the outcome of additional tests these women got during their assessment before and after the 12 week pelvic floor muscle training program .

How can the improvement of vaginal dryness and dyspareunia be explained?

Can it be due to improved:

1. blood flow of vulvovaginal tissue?
2. pelvic floor muscle function?
3. vulvovaginal elasticity?

Blood flow of the vulvovaginal tissue was measured with doppler ultrasound. The main vessels, the internal pudendal artery and the dorsal clitoral artery were checked. The blood flow was measured three times at rest and after three pelvic floor muscle contractions. The pelvic floor muscle function was measured with an intravaginal dynamometric speculum and the Vaginal Atrophy Index was used to assess genitourinary syndrome.

After the 12 week pelvic floor muscle training program the vulvovaginal blood flow increased significantly in all arteries. The relaxation of the pelvic floor muscle after a contraction was significantly faster. The overall Vaginal Atrophy Index and especially the items on skin elasticity and turgor and increase in vaginal mucosa thickness as well as the introitus width improved significantly.

Interestingly the pelvic floor muscle strength did not improve significantly (p=0.051). The authors hypothesise that this might be due to the fact that the women in this study can have a lowered tone of the pelvic floor muscles because of their menopausal state but women can also have a heightened tone due to dyspareunia and because of the small sample size significance was not reached.

My opinion

The results of this study are very interesting and I hope more high quality research in this field (to test the reproducibility of the results) will be done to improve our understanding of the effect of pelvic floor muscle training on symptoms of genitourinary syndrome. I am waiting for the first randomized controlled trial on this subject with hopefully a longer follow-up period as well. A randomized controlled trial can also differentiate between baseline variables like pelvic floor muscle tone (heightened or lowered) and the results on genitourinary syndrome.

Reference:

Mercier J, Morin M, Tang A, Reichetzer B, Lemieux MC, Samir K, Zaki D, Gougeon F, Dumoulin C. Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause. Climacteric. 2020 Feb 27:1-6. doi: 10.1080/13697137.2020.1724942. [Epub ahead of print]