Pregnancy and childbirth are factors that lead to pelvic floor dysfunctions. Lower urinary tract symptoms occur due to the changes caused by pregnancy. During pregnancy, the pelvic floor is important in providing strong pelvic support, maintaining the function and position of the uterus, bladder and rectum, and ensuring urinary continence. Sexual life is also affected due to the physiological, anatomical and psychological changes experienced during pregnancy. It is stated that having healthy pelvic floor muscles is important for genital arousal and orgasm, and that pelvic floor muscle exercises contribute to the improvement in arousal, lubrication and orgasm by increasing blood flow to the pelvis and clitoral sensitivity, and positively affect sexual life. In terms of the type of birth, it is emphasized that vaginal birth is an important risk factor for pelvic floor dysfunction, and the prolonged of the second stage of labor and lacerations are obstetric risk factors that increase the risk of pelvic floor dysfunction. Considering the effects of pregnancy and birth on the pelvic floor and sexuality, it is important to prevent and reduce negative effects. This study was conducted to evaluate the effect of pelvic floor muscle exercises during pregnancy on sexual function, lower urinary tract symptoms and birth process.

This randomized controlled experimental design was conducted in a training hospital between December 2022 and October 2023. The study was conducted with 70 pregnant women, 35 in the experimental group and 35 in the control group. "Personal Information Form, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire‐Female Lower Urinary Tract Symptoms Long Form (ICIQ-FLUTS LF), Mid-Term Evaluation Form, Birth Process Follow-up Form and Pelvic Floor Muscle Exercise Follow-up Form" were used to collect the data. Data collection forms were applied to both groups between at 18-20 weeks of gestation, 26 weeks of gestation, 32 weeks of gestation and between 3-7th days after birth. In addition to routine care practices, the experimental group was trained at the between 18-20 weeks of pregnancy with a training booklet titled "Sexual Life and Pelvic Floor Health During Pregnancy" created by the researcher and a training video on the application of pelvic floor muscle exercise. Pelvic floor muscle exercises were applied to pregnant women for 12 weeks starting from the 20th week of gestation. To the pregnant women in the control group, only data collection forms were applied and routine care practices were performed.

The experimental and control groups were similar in terms of socio-demographic, general health characteristics, obstetric and gynecological characteristics (p>0.05). A statistically significant difference was found between the first evaluation and last evaluation scores of the pregnant women in the experimental group (p=0.001, p<0.05). It was observed that the last evaluation scores of the pregnant women were significantly higher than the first evaluation scores (p<0.05). A statistically significant difference was found between the first evaluation and last evaluation scores of the Arousal, Lubrication, Orgasm and Satisfaction Sub-Dimension (p<0.05). A statistically significant difference was found between the ICIQ-FLUTS LF first and last evaluation scores of the pregnant women in the experimental group (p=0.017, p<0.05). The ICIQ-FLUTS LF post-evaluation scores of the pregnant women were statistically significantly lower than the first evaluation scores (p<0.05). There was a statistically significant difference between the groups in terms of perineal pain (p=0.027, p<0.05). Compared to the experimental group, it was determined that the pregnant women in the control group experienced perineal pain at a higher rate.

It is stated that pelvic floor muscle exercises strengthen the levator ani muscle by providing muscle hypertrophy, increase blood flow to the pelvic floor, heal damaged cells and tissues, and accelerate revascularization. It is stated that weakness of the pelvic floor muscles causes decreased blood flow and vaginal sensation, dyspareunia and inability to orgasm. A study found that women with sexual dysfunction had low pelvic floor muscle strength. In addition, it is stated that the increase in pelvic floor muscle strength causes an increase in clitoral sensitivity, improving arousal, lubrication and orgasm. According to the results of the research, pelvic floor muscle exercise during pregnancy improved sexual function and was compatible with the literature.
Lower urinary tract symptoms are the most common urological complaints seen during pregnancy because pregnancy causes anatomical and functional changes. The hypotonic effect of progesterone on the lower urinary tract, the upward and forward displacement of the bladder due to the uterus, is associated with the prevalence of lower urinary tract symptoms during pregnancy. Pregnancy and childbirth are strong independent factors that cause the onset or progression of urinary incontinence in women of reproductive age. Studies in the literature focus on the effect of pelvic floor muscle exercise on urinary incontinence. The results of this research show that pelvic floor muscle exercises performed during pregnancy are effective in reducing lower urinary tract symptoms by strengthening the pelvic floor and have a positive effect on lower urinary tract symptoms. It can be said that pelvic floor muscle exercises performed during pregnancy reduce postpartum perineal pain.

It was determined that pelvic floor muscle exercise applied to the experimental group during pregnancy improved sexual function, reduced lower urinary tract symptoms and postpartum perineal pain compared to the control group.

Ferreira, C.H.J., Dwyer, P.L., Davidson, M., De Souza, A., Ugarte, J.A., Frawley, H.C., 2015, Does pelvic floor muscle training improve female sexual function? A systematic review, International Urogynecology Journal, 26 (12), 1735-1750.
Moossdorff-Steinhauser, H.F.A., Berghmans, B.C.M., Spaanderman, M.E.A., Bols, E.M.J., 2021, Prevalence, incidence and bothersomeness of urinary incontinence in pregnancy: a systematic review and meta-analysis, International Urogynecology Journal, 32 (7), 1633-1652.
Okeahialam, N.A., Dworzynski, K., Jacklin, P., McClurg, D., 2022, Prevention and non- surgical management of pelvic floor dysfunction: Summary of NICE guidance, The BMJ, 376 n3049.

Continence 12S (2024) 101650
DOI: 10.1016/j.cont.2024.101650