JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · Feb 2026

Examining the Relationship between Adherence to Pelvic Floor Rehabilitation and Improvements in Mental Health Outcomes: A Systematic Review

By Gogia Y, Rishi P, . K

Introduction: Vulvovaginal Atrophy (VVA), a key component of genitourinary syndrome of menopause, significantly impairs sexual function, urinary health, and quality of life in postmenopausal women. While pharmacological therapies such as topical oestrogen are widely used, non-hormonal interventions are increasingly important. Pelvic Floor Rehabilitation (PFR) and Cognitive-Behavioural Therapy (CBT) have individually shown benefits in improving urogenital symptoms and psychological outcomes. However, the combined effect of these interventions remains unclear. Aim: To systematically review and synthesise the evidence on the effectiveness of combined PFR and CBT compared to usual care, PFR alone, CBT alone, or other interventions in postmenopausal women with VVA. Materials and Methods: A comprehensive search was conducted in MEDLINE, Embase, Cochrane CENTRAL, CINAHL, PsycINFO, and Web of Science, as well as ClinicalTrials.gov and WHO ICTRP. Randomised controlled trials and controlled studies will be eligible. Two independent reviewers screened studies, extracted data, and assessed risk of bias using RoB 2 (RCTs) or ROBINS-I (nonrandomised studies). The primary outcomes include VVA symptom severity and sexual function. Secondary outcomes include pelvic floor muscle strength, quality of life, depression, and anxiety. Data was synthesised narratively; meta-analysis was performed where ≥2 comparable trials exist. PRISMA 2020 guidelines were followed. Results: Forty articles met the inclusion criteria. The majority of the studies included physiotherapy interventions such as PFR, CBT in treating postmenopausal women with vulvovaginal atrophy. Exercises, counselling as well as physical therapy are effective to improve vulvovaginal atrophy symptoms and vaginal muscle strength. Conclusion: This systematic review provides consolidated evidence on whether integrating PFR with CBT improves physical and psychological outcomes in postmenopausal women with VVA, informing future rehabilitation strategies and clinical practice.

doi.org/10.7860/jcdr/2026/88435.22910 Open access Interventions