The climacteric comprises the period of transition in woman'slife. In this process, there are functional, morphological and
hormonal changes dueto the decline of endogenouse strogen production, by the cessation of ovarian follicular activities. Changes in this phase maybe as sociated with complaints about urinary function and female sexual function. Related to sexual dysfunctions, low sexual desire, deficit of lubrication, excitation and anorgasmia are commom reported. Regarding to urinary symptoms, urinary tract infections, urge incontinence (UUI), stress incontinence (SUI) and dysuria are frequent complaints. Although pelvic floor muscles (PFM) plays na important role in women's urinary and sexual function, there are still controversies in literature that its streng this directly correlated with the status of urinary continence or with the level of satisfaction of sexual function. The aim of this study was to investigate the strength of the PFM and its correlation with sexual function and urinary symptoms in climacteric women. As well as correlating the strength of MAP with the sexual and urinary function of the these women.

This is a cross-sectional study, performed at a climateric clinic of the Universitary Hospital. From August 2019  to March 2020 women were recruited to participate of this study, initial explanations about the aims and instruments to beused were provided. The inclusion criteria were women aged between 40 and 60 years, with at least one urinary symptom and sexual intercourse in the last month. Initial assessments consisted of sociodemographic and clinical information, the following questionnaires were used: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the Female Sexual Function Index (FSFI)-PFM function was performed using PERFECT scheme and manometric perineometry.
 The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), is a self-administered questionnaire that aims to assess the severity and impact of urinary incontinence on quality of life and qualifies the patient's urine loss. The questionnaire has four questions that assess the following items: frequency, severity, impact and items intended for the knowledge of causes and situations experienced by the patient in relation to UI. The total score is generated by adding the values obtained from questions 3, 4 and 5, knowing that the higher the score, the greater the impact on the interviewees' quality of life.
The FSFI is a translated version, which is a short and self-applicable questionnaire, which involves questions related to the woman's sexual function and activity in the last four weeks. For each question, there was a numerical value where the interviewees marked what approached their reality, with nineteen questions divided into six domains: sexual desire, sexual arousal, vaginal lubrication, orgasm, sexual satisfaction and pain. The answer alternatives gained a score between 0 and 5 in an increasing way related to the presence of the examined function. The total score was given by the sum of the values of the questions that were multiplied by a correction factor, which homogenizes the influence of the domains in the total value obtained. The score ranges from 2 to 36, and the lower the value, the worse the sexual function of the interviewees.
The pelvic floor muscle assessment was performed by digital palpation  asked the participant to perform the maximum contraction followed by relaxation, the sustained contraction followed by relaxation, and repetitions of these contractions up to 10 times. The response was graded according to the PERFECT scheme, with Power evaluating muscle strength (P) scored from 0 (without contraction) to 5 (contraction against strong resistance); Endurance, refers to the time that the patient is able to maintain a maximum contraction calculated in seconds; Repetitions , refers to the number of times that the slow contraction can be repeated maintaining the strength and resistance previously evaluated; Fast Contractions, maximum recorded rapid contractions and, finally, every  timed contractions completing the acronym.

40 women participated of the study, mean age of 52.2 (+- 4 years), 7.5% were married, 52.5% had primary education, 45% of the participants had in come 2 to 3 minimum ages. In the ICIQ-SF questionnaire, all the  womens howed involuntary loss of urine, the frequency of the losses varied between once a week (50%), followed byonce a day (40%), with 85% reportings mall to
moderate incontinence. Most of the participants (82.5%), reported to be uncomfortable with urinary loss and scored 10 in the impact of urinary incontinence in their lives, wich mean a serious impact of quality of life. In the FSFI questionnaire the mean score was 21.61 points. According to total scores, 82.5% showed sexual dysfunction. Out of the six domains of the questionnaire,
orgasm and vaginal lubrication showed worse results with 80% of women reporting difficulty to reaching the sexual a pex. Only 20% reported satisfaction in reaching orgasm during sex, 52.5% reported that the frequency of vaginal lubrication during sexual activity was loworn one, and 77.1% reported difficulty to main taining lubrication during theen tire sexual intercourse.
No correlation was observed between the questionnaires FSFI and ICIQ-SF. In the PERFECT scheme only 15.79% showed power (P) grade 4, 84.21% presented poor static endurance (E) with less of 5 seconds of maintence, with a dinamic endurance (R) of one or two repetitions 53.64%. In the Perineometry assesment 52.63%, had very low PFM pressure. Showed negative correlation between the degree of urinary incontinence, measured by ICIQ-SF questionnaire, and the pressure of contraction of the pelvic floor measured by
the perimeotry exam (p = 0.0424). Sexual function (FSFI) did not correlate positively with perineometry and pelvic floor assessment (PERFECT scheme).

The climacteric is a critical period in the woman's life, in which hormonal changes occur that can directly impact the physical and sexual health of these women. The results of this study indicate that sexual dysfunction is highly prevalent in climacteric women. As in other literature, they point out the important aspect to be observed by health professionals working in the area (BRASIL, 2016).
Especially noteworthy are the aspects of deficit in vaginal lubrication that significantly impact the quality of sexual intercourse and impede the advancement of the female physiological sexual response, resulting in the difficulty of reaching orgasm as well as, generating pain or discomfort during or after vaginal penetration. (BARREIROS, BR; et al .; 2020). Smoking, alcohol consumption, prolapse and urinary incontinence are risk factors for sexual dysfunction.bHowever, no correlation was
found between these findings and the characteristics assessed. The strength of the pelvic floor is directly related to the urinary continence function in menopausal women, as observed in other studies [2] and the manual palpation test (PERFECT scheme) is an important tool for the clinical evaluation of urinary incontinence, considering women with muscle weakness.[3]

The result of this study reinforces that the strength of the pelvic floor musculature is directly related to the urinary continence function, and demonst rates that the bidigital palpation tests and evaluation by Perineometry are use fuland important tools for the clinical evaluation of urinary incontinence, being correlated each ther. The small number of participants shows the need for further studies to corroborate this theme.

Farrell Am E. Genitourinary syndrome of menopause. Aust Fam Physician 2017;46:481–4.
Oliveira, A. H. F. V.; et al.Physiotherapy for urinary incontinence in menopausal women. Rev Ciênc Méd.;26(3):127-133; 2017.
Messelink B, Benson T, Berghmans B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: Report from the Pelvic Floor Clinical Assessment Group of the International Continence Society. Neurourol Urodyn 2005;24: 374–80