The effect of antenatal pelvic floor muscle exercises on female sexual function: A randomised controlled trial

In this study, the intervention will consist of training on how to perform pelvic floor muscle exercise. The researcher (PhD Candidate) will be teaching women on how to perform pelvic floor muscle exercises.{The researcher is a registered midwife, has been providing care and education to women across midiwfery practice from antenatal care, labour and birth and postnatal care. She is currently a PhD candidate of midiwfery. She also has a research background on pelvic organ prolapse, urinary incontinece and their association with pelvic floor muscle strength. To design the intervention in this study, arrangment with physiotherapy department has been done to stay consistent with current practice and also to receive supplementary materials such as pamphelet 06 on the benefit of pelvic floor exercise published by Australian Continence association, as stated in next section). To develop intervention in this trial the following published resources were used including; ( “(The knack”) (Miller, Ashton-Miller, & DeLancey, 1998) and the study carried out by Elbegway et al (Elbegway et al., 2010) Morkved.“(The knack) (Miller, Ashton-Miller, & DeLancey, 1998; Miller, Sampselle, Ashton-Miller, Hong, & DeLancey, 2008), the studies carried out by Elbegway et al (Elbegway et al., 2010), Morkved et al ((Mørkved et al., 2003)), Morkved et al (Mørkved & Bø, 2014) and Alves et al (Alves, de Carvalho Cavalli, Bertacini, & Driusso, 2016) The initial session will be individual face to face training and is estimated to take 30 minutes. Women will be instructed as follows: 1. Squeeze the anal sphincter, the vaginal and urethral as tightly as possible. 2. To increase the intensity of their effort. 3. To hold the contraction as tightly as they can for 8-10 seconds. 4. To relax their effort, allowing their muscle to relax and rest for 8-10 seconds. 5. To repeat the sequence 8 times 6. To perform five fast pelvic floor muscle contractions after completing slow contractions. 7. To perform one set of 13 PFME (eight slow and five fast) three times a day. 8. 7. To do this daily. Women will be instructed to coordinate breathing with pelvic floor muscle contractions. The women will be explained to lift up and inward around urethra, vagina, rectum, and squeeze as hard as they can and hold it for 8-10 seconds before relaxing the muscles gently. Women will be asked to keep breathing in and out during the contractions (Mørkved & Bø, 2014). Women will be instructed to perform PFME in different positions so they can choose the most comfortable position to practice PFME at home. Women will be also instructed of the knack method. Women in the intervention group will also be provided a compliance diary to record their exercises daily. Red stick up spots will be given to use as triggers on shower, teeth, meals, queues etc) will be used to remind women to do the exercises as this has been demonstrated to be effective (Miller et al., 1998). Women will be instructed to perform pelvic floor muscle exercises in different positions and also to grip up before cough, sneeze, lift, bend. They will be encouraged to continue these exercise in the postpartum as above and also incorporating good bladder habits. Women will receive telephone follow up fortnightly. Follow up will stop after birth. There will not be any fortnightly follow up in the postpartum period. Intervention will cease when women in intervention group give birth. Women in both control and intervention groups will be contacted once at three months after birth to collect data. The duration of intervention is from 20 weeks of pregnancy until birth. The study setting is antenatal clinic of Westmead Public Hospital, Low risk primiparous pregnant women will be recruited at antenatal clinics at less than 22 weeks gestation and will be randomised to control and training group. Training group will receive routine antenatal care as well as an individual face to face instruction on how to perform pelvic floor muscle exercise as stated above and will receive fortnightly follow up via text messages. Women will be provided diary to record their compliance. Women in intervention group will be provided additional pamphlets to read. The pamphlet is the vision 06 titled "Pelvic floor muscle training for women" published by continence foundation of Australia and is available at Westmead hospital.