The Pelvic Floor Muscles Strength and Sexual Function in Primigravid and Non-pregnant Nulliparous
Condition: Sexual Behavior
Study type: Observational

Summary: 
      This study has two aims: a) to evaluate the pelvic floor muscles strength in primigravid and
      non-pregnant nulliparous women and to correlate with their sexual function and b) to compare
      PFM strength and sexual function between women in the second and third pregnancy trimesters.
    

Detailed description: 
      This is an observational cross-sectional study. The sample consisted of 161 women divided
      into two groups: the first of pregnant women, formed by 81 primigravidae participants in the
      Prenatal Program of the public health system in Uberlandia city (Brazil). The second consists
      of 80 non-pregnant nulliparous. All participants signed an informed consent and the study was
      approved by the Ethics Committee of the Federal University of Uberlandia (nº 145.623/2012).

      To estimate the average strength of vaginal palpation and vaginal squeeze pressure in
      primigravid, the investigators used the following equation to scale the sample: Zα/2 refers
      to the probability (α/2) standard one-tailed normal distribution; σ2 is the variance
      associated with vaginal palpation and vaginal squeeze pressure; ε is the sampling error.
      Based on a similar study, which evaluated similar population, it was assumed: α=0.05, σ=1.34
      and ε=0.32 for vaginal palpation; and it was assumed: α=0.05, σ=12.60 and ε=3.00 for vaginal
      squeeze pressure. Therefore, the sample size would be 67 and 68 women, respectively.

      The PFM assessment

      PFM evaluation was performed by vaginal palpation and vaginal squeeze pressure. These methods
      are widely used in research involving the female pelvic floor and many studies have shown its
      reproducibility and validity.

      The same examiner conducted all evaluations and before the start of the study, the
      reproducibility was tested. Ten women were evaluated twice, with an interval of one week to
      determine the intraclass correlation coefficient (ICC) of all variables.

      The participants were asked about the health history. After checking that they were eligible
      to participate in the survey, participants were invited to empty the bladder and to remain in
      the supine position with hips and knees flexed and feet propped. Assessments began after
      explaining how to perform the contraction of PFM and the volunteer was advised to stay
      relaxed and breathing normally. The vaginal palpation was always the first exam to check the
      PFM contraction ability and then was held vaginal squeeze pressure exam.

      During vaginal palpation the examiner quantified strength. The physiotherapist introduced the
      index and middle fingers about 4cm inside the vagina, and requested to hold the maximum
      contraction of the PFM, according to the instruction of a movement "inward and up" with the
      greatest possible strength. Muscle function was classified by the Oxford Scale Modified, with
      varies from zero (absence of muscle contraction) to five (strong contraction with finger
      sucking of the evaluator). To be considered valid, the movement of cranial elevation was
      observed by the examiner, as well as the absence of visible contractions of the adductor
      muscles of the hip, gluteus or abdominals.

      The vaginal squeeze pressure was measured through perineometer equipped with a vaginal probe
      that has been covered with a non-lubricated condom and then the probe was lubricated with
      hypoallergenic gel. The probe sensor was connected to a microprocessor hand with a latex
      tube, which allows the measurement of nip pressure in centimeters of water. To obtain the
      measurements, the subjects remained positioning and vaginal sensor was introduced
      approximately 4cm into the vaginal cavity. The women were oriented and motivated verbally to
      perform three voluntary maximal contractions sustained for five seconds and one minute
      interval between them. For statistical analysis, the investigators used the mean of three
      peak pressures provided by the equipment.

      Sexual function assessment

      Sexual function was evaluated by the Female Sexual Function Index (FSFI) questionnaire, with
      a validated Portuguese version, which has an easy to understand language and subsequently was
      applied exclusively in Brazilian pregnant women. The questionnaire consists of 19
      multiple-choice questions, which involves six sexual response domains: desire, arousal,
      lubrication, orgasm, satisfaction and pain. The score for each question is individual,
      varying from 0 to 6 points. The investigators performed a mathematical calculation, which
      allowed the acquisition of a ﬁnal index, the total score of the FSFI. The total score of FSFI
      ranges between 2 and 36 points. The lower the score, the worse is the sexual function is. The
      assessment is for the period of the last four weeks.

      At the time of the interview, the pregnant women were instructed regarding the completion and
      they had their enough time to fill it out in a self-administered way in a reserved place.

      Statistical analysis

      Statistical analysis was performed using Statistical Package for Social Sciences software
      (SPSSV21, Chicago, IL). Data normality was tested by the Kolmogorov-Smirnov test. To perform
      the variables comparison, the Mann-Whitney test was performed. To verify the correlation
      between the variables, the Spearman correlation test was used. Values of p<0.05 were
      considered significant. The intensity of the relationship of the correlation coefficient
      values were interpreted according to the following guidelines: 0 = zero; 0.10-0.39 = weak;
      0.40-0.69 = moderate; 0.70-0.99 = strong, 1 = perfect, regardless of whether positive or
      negative.
    

Intervention name(s): Pelvic floor muscle and sexual function evaluation
Intervention type(s): Other
Intervention description(s): PFM evaluation was performed by vaginal palpation and vaginal squeeze pressure. During vaginal palpation the physiotherapist introduced the index and middle fingers about 4cm inside the vagina, and requested to hold the maximum contraction of the PFM. Muscle function was classified by the Oxford Scale Modified.
The vaginal squeeze pressure was measured through Perineometer.To obtain the measurements, the subjects remained positioning and vaginal sensor was introduced into the vaginal cavity. The women were oriented and motivated verbally to perform three voluntary maximal contractions sustained for five seconds and one minute interval between them.
Sexual function was evaluated by the Female Sexual Function Index (FSFI) questionnaire. The questionnaire consists of 19 multiple-choice questions, which involves six sexual response domains: desire, arousal, lubrication, orgasm, satisfaction and pain.
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        The sample consisted of 154 women divided into two groups: the first of pregnant women,
        formed by 76 primigravidae participants in the Prenatal Program of the public health system
        in Uberlandia city (Brazil). The second consists of 78 non-pregnant nulliparous.
      
Keywords: Pelvic Floor; Pregnancy; Physical Therapy Specialty