Physiotherapy in the Treatment of Sexual Dysfunctions: Current Evidence and Emerging Trends

Pelvic‑floor physiotherapy (PFP) has emerged as a conservative, low‑risk treatment for several sexual dysfunctions. To map its contemporary evidence base, we performed a systematic scoping review of PubMed, Embase, Scopus and Web of Science (2015 – February 2025) for randomised, quasi‑experimental and cohort studies that centred on pelvic‑floor interventions in adults with erectile dysfuncton(ED), premature ejaculation (PE), genito‑pelvic pain disorders (GPPPD) or orgasmic dysfunction. Seventy‑six studies met the criteria, including 36 randomised controlled trials that were appraised with RoB 2 or ROBINS‑I and graded with GRADE. Structured pelvic‑floor muscle training (PFMT) increased International Index of Erectile Function‑5 scores by about five points and sustained the benefit for up to 24 months. In PE, PFMT roughly doubled intravaginal ejaculatory latency time and lowered Premature Ejaculation Diagnostic Tool scores by four to five points. Across 29 studies of GPPPD, PFMT with or without manual therapy reduced pain by 2.4 cm on a 10‑cm visual‑analogue scale and, when combined with graded dilators for vaginismus, increased pain‑free penetration to 68 % versus 45 % with counselling alone. Five small trials in female orgasmic dysfunction showed modest but promising gains in orgasm and total Female Sexual Function Index scores, although overall certainty remains low. Digital adjuncts—including wearable electromyography biofeedback, telerehabilitation and virtual‑reality–guided training—improved exercise adherence by 20 – 30 % and proved non‑inferior to in‑clinic PFMT in two trials. Collectively, the evidence supports PFP as an effective, durable and safe intervention across multiple sexual dysfunctions; priority areas include large multicentre trials, consensus outcome sets and optimisation of neuromodulation parameters to enhance reach and long‑term maintenance of treatment gains.