Gopal Arpita, Sydow Rebecca, Block Valerie, Allen Diane D
Department of Physical Therapy and Rehabilitation Science (AG, RS, DDA), University of California, San Francisco, CA, USA.
Weill Institute for Neurosciences, Department of Neurology (VB), University of California, San Francisco, CA, USA.
Int J MS Care. 2021 Sep-Oct;23(5):213-222. doi: 10.7224/1537-2073.2020-039. Epub 2021 Mar 10.
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.
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 () and 95% CIs were calculated within and across studies.
Eight studies met the inclusion criteria. Combined effects were significant and large across six studies for sexual function ( = 0.82, 95% CI, 0.57-1.06), moderate across seven studies for sexual satisfaction ( = 0.65, 95% CI, 0.43-0.87), and moderately large across two studies for emotional well-being ( = 0.78, 95% CI, 0.17-1.40). Between-group differences reached significance for sexual satisfaction ( = 0.29, 95% CI, 0.03-0.55).
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.
多发性硬化症（MS）患者经常报告性功能障碍，这种情况可能导致性满意度低下和生活质量下降。尽管性功能障碍通常采用药物治疗，但物理治疗师，尤其是那些接受过盆底物理治疗（PT）培训的治疗师，具备良好的能力来解决导致性功能不佳的各种损伤问题。本文分析了PT干预在改善性功能障碍、性满意度以及生活质量的情感幸福方面有效性的现有证据。
检索截至2019年12月的PubMed、CINAHL和PEDro数据库。纳入的文章要求参与者临床诊断为MS，报告存在性功能障碍或性交疼痛，并且接受了PT范围内针对性功能障碍的干预。两位作者分别独立从每项研究中提取均值和标准差。在研究内部和研究之间计算效应量（）和95%置信区间。
八项研究符合纳入标准。六项研究中，性功能的综合效应显著且较大（= 0.82，95%置信区间，0.57 - 1.06）；七项研究中，性满意度的综合效应中等（= 0.65，95%置信区间，0.43 - 0.87）；两项研究中，情感幸福的综合效应中等偏大（= 0.78，95%置信区间，0.17 - 1.40）。组间差异在性满意度方面达到显著水平（= 0.29，95%置信区间，0.03 - 0.55）。
通过各种PT干预可以有效解决性功能、性满意度和情感幸福问题。高效的干预措施包括盆底肌肉训练和正念训练。未来的研究应将PT干预与非PT对照进行比较，以确定该人群的最佳治疗方案。
