Abstract
Background: Polycystic ovary syndrome (PCOS) is a major cause of anovulatory infertility and is accompanied by metabolic, psychological, sexual, and quality-of-life disturbances. Pelvic floor dysfunction may represent an under-recognized component of reproductive and sexual health in some affected women. Objective: To evaluate whether structured pelvic floor rehabilitation improves conception and pelvic health outcomes in women with PCOS, infertility, and occult pelvic floor dysfunction. Methods: This parallel-group randomized controlled trial included 72 women allocated equally to an eight-week structured pelvic floor rehabilitation programme or standard care. Rehabilitation comprised supervised pelvic floor muscle training, biofeedback-guided exercises, manual therapy, relaxation training, breathing coordination, and a daily home-exercise programme. Follow-up data were available for 63 participants (intervention n=32; control n=31). Outcomes included conception during follow-up, pelvic floor strength assessed with the Modified Oxford Scale (MOS), sexual function assessed with the Female Sexual Function Index (FSFI), pelvic pain, and quality of life. Results: Conception occurred in 11/32 (34.4%) women in the intervention group and 4/31 (12.9%) controls, corresponding to an absolute risk difference of 21.5 percentage points (95% CI 1.2–41.7; p=0.045) and a crude risk ratio of 2.66 (95% CI 0.95–7.48). Post-intervention MOS scores were 3.4±0.7 versus 2.5±0.6 (mean difference 0.90, 95% CI 0.57–1.23; p<0.001). FSFI scores were higher in the intervention group (24.1±3.8 vs 20.2±3.6; p<0.001), while pain scores were lower (2.1±1.0 vs 3.6±1.2; p<0.001) and quality-of-life scores were higher (78.4±6.5 vs 69.2±7.1; p<0.001). Conclusion: Structured pelvic floor rehabilitation improved pelvic floor strength, sexual function, pain, and quality of life and was associated with a higher observed conception proportion during short-term follow-up. The fertility estimate was imprecise, and larger randomized trials with longer reproductive follow-up and complete randomized-participant analyses are required.