The flowchart of the study is presented in Figure 1. It included 22 manuscripts published between 1993 and 2020, with a total of 304 participants.
Table 4 in the Appendix presents the characteristics of the included studies. Studies were conducted in different parts of the world: two (9.1%) studies were from South America [13, 14]; four (18.2%) from North America [15,16,17,18]; ten (45.4%) from Europe [19,20,21,22,23,24,25,26,27,28]; two (9.1%) from Asia [29, 30] and three (13.6%) from Oceania [31,32,33]. One study (4.5%) did not report where data collection took place .
Of the 22 included manuscripts, 13 (59%) aimed to understand the experience of women with PFMS. [13, 14, 20, 22,23,24, 27,28,29,30, 32,33,34]three (13.6%) with vaginal dilators [21, 25, 31]three (13.6%) with pessaries [16,17,18] and one (4.5%) with perineal massage . One study (4.5%) aimed to understand women’s experience using practical physiotherapy interventions to treat sexual dysfunction and another (4.5%) investigated women’s experience with pessaries and PFMT use. .
Synthesis of the results
The synthesis of the qualitative results is presented below: I) women’s experience in manual interventions; II) the experience of women in the use of vaginal devices changes according to the attitudes of health professionals; III) women’s experiences with the use of vaginal devices varied according to pelvic floor dysfunction; IV) reported side effects due to the use of vaginal devices; V) external factors that influence the performance of the PMSC; VI) the perception of women of their own personal factors that influence the performance of the EMPP; VII) characteristics of the EMPP that influence the adherence of women; VIII) strategies used by women to include the EMPP in their routine. The narrative fragments of the findings are presented in Table 2.
Synthesized findings I: Women’s experience with manual interventions
Women undergoing physiotherapy treatment with perineal massage to treat painful sexual ailments reported its profound impact on a physical, emotional and social level [15, 26]. They reported that the care provided by health professionals was careful and they felt that their complaints were taken seriously. The treatment makes them have a better perception of their bodily sensations, as well as the feeling of great relief while the muscle spasms decrease (Table 2—P.1, P.3). All of the women reported feeling “getting better” after treatment.
Synthesized findings II: The experience of women with the use of vaginal devices changes according to the attitudes of health professionals
The studies presented the experience of women who had undergone pelvic radiotherapy [21, 31]as well as women diagnosed with vaginismus POP or user interface [16,17,18,19]. Although there are differences in the sample studied, it is necessary to highlight a point in common: the communication between the health professional and the patient. The communication aspect of treatment seems to have a negative influence on women’s experience with the use of vaginal dilators, whereas it has a more positive impact during the use of pessaries (Table 2—P.4).
Women seem to become insecure when using vaginal dilators [21, 25, 31] due to conflicting information provided by healthcare professionals with different levels of communication skills, however, some women described support from healthcare professionals as essential to providing a good treatment experience [16,17,18,19]. Poor interaction between healthcare professionals and patients was reported as a reason for treatment discontinuation (Table 2—P.5).
Synthesized Findings III: Women’s experiences with the use of vaginal devices varied according to their pelvic floor dysfunction
For some women, the use of vaginal devices was simply one aspect of their treatment to reduce discomfort with their symptoms (Table 2—Q.7), while others perceived the use of a vaginal dilator as a constant confrontation with the reality of the cancer (Table 2). —P.8). Only those pessary users reported having an active role in the process of choosing or not choosing this treatment option. The reason for not choosing this treatment was based on the experiences of other women.
Although some women with vaginismus reported a positive experience, most described it as “painful,” “humiliating,” and even “traumatic.” The smallest vaginal dilator was considered too large, leading women to seek alternatives (eg, vibrators and tampons). The transition between devices was difficult due to the jump in size. They stated that their journey would be easier if they had the support of peers, professionals, and peers. In contrast, women who used pessaries reported that it took some time to learn how to use them effectively, and once they learned how to handle them, they perceived the treatment as a life-changing experience, using words such as “freedom”, “security”. ” and “satisfaction” (Table 2—P.9, P.10).
IV Synthesized Findings: Reported Side Effects Due to Use of Vaginal Devices
Only studies on vaginal dilators had reports of side effects, including blood loss, pain, and vaginal discharge (Table 2—P.11, P.12). These negative experiences seem to result in anxiety, but also as motivation to continue using dilators. Reported strategies for reducing negative feelings were increasing positivity and integrating treatment into daily life, such as during a bath (Table 2—P.13). The sexuality involved in the use of the vaginal dilator was a controversial experience (Table 2—P.14).
Summary conclusions V: External factors that influence the performance of the EMPP
The extrinsic factors that seem to influence the performance of the EMPP are the support of health professionals and family (Table 2—P.15). Health professionals were considered potential facilitators or barriers to the performance of the PFMT (Table 2—P.16). Some women did not adequately accept their complaints from some health professionals and felt the need to receive further instructions in order to perform PFMT. These women complained that when they received the information it was not in the appropriate way (Table 2—P.17). However, when the information and support were provided appropriately, it helped them to adhere to the PFMT.
Synthesized findings VI: Women’s perception of their own personal factors that influence PHME performance
This topic has three subtopics:
Category I: Positive personal factors. A positive experience for women who underwent PFMS was reported to be a feeling of control over their bodies (Table 2—P.18). To avoid incorrect training, women considered the ability to perceive and confirm their ability to perform their PFMT important, in order to improve their commitment and confidence in their own ability to perform PFMS (Table 2—P.19, P.20 ) and reduce their symptoms. One participant mentioned putting her own competitiveness in mobile application games as a positive factor for doing PMSC (Table 2—P.21).
Category II: Negative personal factors. The women mentioned the following negative factors: lack of motivation; previous negative experience with PMSC; uncertainties about the results or lack of good results; limited understanding of how EMSP works; shame or conflicting feelings about eroticization (Table 2—P.22); difficulties in the performance of EMSP, including the “invisibility” of the muscle; uncertainty about whether or not they were correctly contracting their PFM (Table 2—P.23); emotional, mood and climatic factors; Guilty for not performing PMSC; worsening of symptoms; loneliness while performing PMSC; perception that the EMPP is boring or a waste of time; and the naturalization of PFD symptoms.
Category III: perineal perception. While some women reported an inability to perceive a correct MSP contraction, some noted that they could progressively perceive it and tell whether they were performing it correctly or not (Table 2—P.24, P.25).
Synthesized findings VII: The characteristics of the EMPP influence the adherence of women
Some women considered that they have better adherence to PFMT performed in a group, while others classified PFMT as a quiet “private exercise” (Table 2—P.26).. While for some women PFMS could be done at any time of day without anyone else knowing, others emphasized their need for a quiet place to focus. One notable positive point was the association of PMSC with other benefits, such as improved self-confidence. The commitment involved in becoming a participant in clinical studies was perceived as the very obligation of adhering to treatment. It is worth noting that some participants did not consider the PFMT a “real exercise” (Table 2—P.26). This deconstruction of the EMSP as a physical exercise was justified by the anatomical region of the PFMS and by the possibility of contractions during penetrative vaginal sex.
Synthesized findings VIII: Strategies used by women to include PFMT in their routine
Some participants justified their lack of adherence to the EMSP due to lack of time to do it. Other participants were able to include PFMT in their routine by associating it with activities of daily living, such as doing the exercise while waiting for the bus or doing it every time they sit in a computer chair, among other situations (Table 2—P.28 ). ).
Evaluation of quality criteria
Table 4 shows that only four studies reported the use of any type of quality criteria and only one manuscript reported the use of the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Table 3 presents the results of the analysis of the quality criteria of the studies. Only six (26.1%) articles received the maximum score for section A, and 21 (91.3%) articles were considered to have clear (section B) or relevant (section C) results. The quality of most of the included manuscripts was limited in aspects of methodology. There was a high number of manuscripts that did not present clear information on the recruitment strategies, nor on the relationship between the researchers and the participants.