Comparative effectiveness of motivational interviewing versus pelvic floor muscle training on sexual function in women with endometriosis: an active-controlled randomized trial
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A randomized trial found that both motivational interviewing and pelvic floor muscle training significantly improved sexual function in women with endometriosis, with no statistically significant difference between the two interventions.
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This randomized trial compared the effectiveness of motivational interviewing and pelvic floor muscle training on sexual function in women diagnosed with endometriosis. Sixty participants were assigned to receive six weekly virtual sessions of either intervention, with sexual function measured using the Female Sexual Function Index at baseline, post-intervention, and two months later. The results indicated that both groups experienced significant improvements in sexual function scores over time, with no statistically significant differences observed between the two treatment approaches. This paper is centrally about endometriosis — specifically evaluating non-invasive interventions for managing endometriosis-related sexual dysfunction.
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Abstract
Endometriosis profoundly impairs sexual function in women. Despite evidence supporting motivational interviewing (MI) and pelvic floor muscle training (PFMT) separately, no study has directly compared these two approaches on sexual function in endometriosis. This trial compared the effectiveness of MI versus PFMT on sexual function in women with endometriosis. This parallel-group, active-controlled randomized trial was conducted at Baghaeipour Clinic, Yazd, Iran (October 2024 – April 2025). Sixty women with endometriosis (30 per group) were randomly assigned to six weekly 90‑minute sessions of MI or PFMT delivered virtually. Both groups received routine care including lubricant gel. Sexual function was measured using the Female Sexual Function Index (FSFI) at baseline (T0), immediately post‑intervention (week 6, T1), and two months after intervention completion (week 14, T2). Data were analyzed using independent t‑tests, Chi‑square tests, and repeated‑measures ANOVA. Fifty‑four participants (27 per group) completed the study. Both groups were homogeneous at baseline. In the MI group, mean FSFI scores improved from baseline to T1 (17.82 ± 6.80 to 22.07 ± 7.41, p < 0.001) and to T2 (26.10 ± 3.35, p < 0.001), with sustained improvement from T1 to T2 (p < 0.001). In the PFMT group, scores improved from baseline to T1 (17.07 ± 6.04 to 23.43 ± 5.28, p < 0.001) and to T2 (24.30 ± 5.62, p 0.05). Time had a significant effect (p < 0.001), but neither group (p = 0.880) nor time‑group interaction (p = 0.418) was significant. Both motivational interviewing and pelvic floor muscle training were associated with improved sexual function in women with endometriosis. No statistically significant difference was observed between the interventions. Both approaches offer non-invasive, complementary options for managing endometriosis-related sexual dysfunction, though further large-scale research is needed to confirm these findings and establish comparative long-term efficacy. This research was registered in the Iranian Registry of Clinical Trials (IRCT20240623062218N1) on 2024-09-14. Endometriosis can negatively affect sexual health and quality of life. This study compared two non-drug approaches, motivational interviewing (MI) and pelvic floor muscle training (PFMT), to improve sexual function in women with endometriosis. Sixty women were randomly assigned to receive six weekly online sessions of either MI or PFMT. Sexual function was assessed at baseline, immediately after the six-week intervention, and at the two-month follow-up. Fifty-four women completed the study. Sexual function improved significantly over time in both groups. However, there was no significant difference between the two interventions, and neither approach was shown to be superior. These findings suggest that both MI and PFMT may be feasible and useful complementary approaches for managing sexual dysfunction related to endometriosis. Larger studies with longer follow-up and appropriate control groups are needed to confirm these findings.
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Abstract
Background
Endometriosis profoundly impairs sexual function in women. Despite evidence supporting motivational interviewing (MI) and pelvic floor muscle training (PFMT) separately, no study has directly compared these two approaches on sexual function in endometriosis. This trial compared the effectiveness of MI versus PFMT on sexual function in women with endometriosis.
Methods
This parallel-group, active-controlled randomized trial was conducted at Baghaeipour Clinic, Yazd, Iran (October 2024 – April 2025). Sixty women with endometriosis (30 per group) were randomly assigned to six weekly 90‑minute sessions of MI or PFMT delivered virtually. Both groups received routine care including lubricant gel. Sexual function was measured using the Female Sexual Function Index (FSFI) at baseline (T0), immediately post‑intervention (week 6, T1), and two months after intervention completion (week 14, T2). Data were analyzed using independent t‑tests, Chi‑square tests, and repeated‑measures ANOVA.
Results
Fifty‑four participants (27 per group) completed the study. Both groups were homogeneous at baseline. In the MI group, mean FSFI scores improved from baseline to T1 (17.82 ± 6.80 to 22.07 ± 7.41, p < 0.001) and to T2 (26.10 ± 3.35, p < 0.001), with sustained improvement from T1 to T2 (p < 0.001). In the PFMT group, scores improved from baseline to T1 (17.07 ± 6.04 to 23.43 ± 5.28, p < 0.001) and to T2 (24.30 ± 5.62, p 0.05). Time had a significant effect (p < 0.001), but neither group (p = 0.880) nor time‑group interaction (p = 0.418) was significant.
Conclusion
Both motivational interviewing and pelvic floor muscle training were associated with improved sexual function in women with endometriosis. No statistically significant difference was observed between the interventions. Both approaches offer non-invasive, complementary options for managing endometriosis-related sexual dysfunction, though further large-scale research is needed to confirm these findings and establish comparative long-term efficacy.
Trial registration
This research was registered in the Iranian Registry of Clinical Trials (IRCT20240623062218N1) on 2024-09-14.
Plain English Summary
Endometriosis can negatively affect sexual health and quality of life. This study compared two non-drug approaches, motivational interviewing (MI) and pelvic floor muscle training (PFMT), to improve sexual function in women with endometriosis. Sixty women were randomly assigned to receive six weekly online sessions of either MI or PFMT. Sexual function was assessed at baseline, immediately after the six-week intervention, and at the two-month follow-up. Fifty-four women completed the study. Sexual function improved significantly over time in both groups. However, there was no significant difference between the two interventions, and neither approach was shown to be superior. These findings suggest that both MI and PFMT may be feasible and useful complementary approaches for managing sexual dysfunction related to endometriosis. Larger studies with longer follow-up and appropriate control groups are needed to confirm these findings.
Abbreviations
- RCT:
-
Randomized Controlled Trial
- MI:
-
Motivational Interviewing
- PFMT:
-
Pelvic Floor Muscle Training
- FSFI:
-
Female Sexual Function Index
- IRCT:
-
Iranian Registry of Clinical Trials
Acknowledgements
The authors would like to thank Shahid Sadoughi University of Medical Sciences for supporting this research.
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This research did not receive funding.
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Ethical approval for this study was obtained from the Research Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran (IR.SSU.REC.1403.022). All participants were 18 years of age or older. Written informed consent was obtained from all participants prior to enrollment. All methods were carried out in accordance with the Declaration of Helsinki.
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Raeisian, Z., Farajkhoda, T., Javaheri, A. et al. Comparative effectiveness of motivational interviewing versus pelvic floor muscle training on sexual function in women with endometriosis: an active-controlled randomized trial. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04856-7
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DOI: https://doi.org/10.1186/s12905-026-04856-7
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