Abstract Introduction Problems with the domains of sexual function—desire, arousal, orgasm, and pain—are highly prevalent during perimenopause. Individual studies have revealed the importance of biopsychosocial factors for sexual function during this reproductive transition; however, our understanding of risk and protective factors remains equivocal. To address this critical gap in knowledge, we conducted a systematic review examining biological, psychological, and social/interpersonal correlates and predictors of sexual function (ie, desire, arousal, orgasm, pain) in perimenopause. Methods A systematic review of 42 studies focusing on perimenopausal women was conducted. Studies were included if they assessed biological (eg, hormonal levels, menopause symptoms), psychological (eg, mood, stress, resilience), or social/interpersonal (eg, relationship quality, intimacy) factors in relation to sexual function. Findings were narratively synthesized to identify consistent predictors and gaps across domains of sexual function. Results With regard to biological factors, hormonal changes showed either no association or inconsistent associations with sexual function, whereas urogynecological menopause symptom severity was consistently associated with poorer sexual function. Psychological risk factors (eg, depression, anxiety, stress) were consistently associated with poorer sexual function outcomes, whereas resilience factors (eg, relationship quality, overall health) were associated with better sexual function in perimenopause. Assessment of social/interpersonal factors revealed that interpersonal factors (eg, relationship satisfaction and intimacy, low conflict) were associated with greater sexual function, whereas factors such as relationship length were not. The evidence linking other social factors (eg, sociodemographics) and sexual function was mixed. This systematic review also revealed important limitations of the current literature. Most notably, reliance on cross-sectional designs, which preclude estimates of change over time, inconsistent and sometimes poor measurement of sexual function, and conflation of perimenopause with other menopausal stages. Conclusion This review demonstrates that sexual function during perimenopause is influenced by interconnected biological, psychological, and social factors. Biological changes—particularly menopause-related symptoms—play a significant role, though hormonal influences remain inconsistent. Psychological factors and relationship quality also contribute meaningfully to sexual function, underscoring the multifactorial nature of sexual health in this transitional stage. Taken together, the results of this systematic review underscore the importance of a biopsychosocial approach to understanding and addressing sexual function problems in perimenopause and highlight the need for advancing targeted research and intervention during this vulnerable period.
Introduction Endometriosis (EM) is frequently associated with chronic pelvic pain (CPP) and dyspareunia, often linked to secondary pelvic floor dysfunction and hypertonicity. To evaluate whether the use of an intravaginal electromyography (EMG) biofeedback and electrostimulation device reduces pain and improves quality of life in patients with EM. Methods In this prospective single-arm-real-world clinical study, 201 women with endometriosis used a home-based intravaginal device for three months (up to eight sessions per week). The intervention included two programs: (1) electrical stimulation via a vaginal probe and (2) an EMG biofeedback program for monitoring and training pelvic floor muscle activity. Sessions lasted 30 minutes and intensity was self-adjusted. Pain outcomes were assessed before and after treatment using standardized scales. Paired comparisons were analyzed using the Wilcoxon signed-rank test, and linear regression was used to evaluate associations between frequency of device use and treatment outcomes. The primary outcomes were changes in pelvic floor pain and dyspareunia, with secondary outcomes including dysmenorrhea, dysuria, dyschezia, and cyclic or acyclic abdominal pain. Results Of the 201 participants, 107 completed the study and 94 dropped out. Pelvic floor pain decreased significantly from 6.0 [3.75-7.25] at baseline to 1.5 [0.0-5.0] after three months (P < .001), and dyspareunia decreased from 7.0 [5.0-8.25] to 5.0 [3.0-7.25] (P < .001). Improvements were also observed in dysmenorrhea (P = .037) and dysuria (P = .014). No significant changes were found in cyclic or acyclic abdominal pain or dyschezia (P > .05). Participants using the device more than three times per week experienced greater reductions in dyspareunia (B = -1.27, 95% CI [-2.38 to -0.21]) compared to those with lower usage, while pelvic floor pain improvements were similar across usage groups. Discussion Home-based intravaginal EMG biofeedback and electrostimulation may represent a supportive therapeutic option for managing pelvic floor-related pain in EM patients. The prospective design and assessment of a home-based intervention in a real-world setting enhance the clinical relevance of the findings. However, the single-arm design without a control group, the relatively high dropout rate, and the reliance on self-reported outcomes should be considered when interpreting the results. Home-based use of an established CE-certified EMG biofeedback and electrical stimulation device was associated with significant improvements in pelvic floor pain and dyspareunia in women with endometriosis. Controlled studies are warranted to confirm these findings and establish efficacy.
Abstract Introduction Marital satisfaction is a key determinant of psychological well-being; however, no validated Urdu version of ENRICH Marital Satisfaction Scale (EMSS) previously existed for Pakistani clinical populations. This study aimed to translate, culturally, and psychometrically validate an Urdu version of the EMSS (EMSS-PK) for use among married men with sexual dysfunction in Pakistan. Methods A cross-sectional psychometric validation study was conducted between September 2024 and June 2025 in Karachi, Pakistan. One hundred and fifty married Pakistani men aged 25-40 years presenting with sexual dysfunction were recruited from outpatient psychiatry, psychology, and urology clinics. The EMSS was subjected to five-step forward–backward translation, expert panel review, and pilot testing. Psychometric analysis included exploratory factor analysis (EFA; principal component extraction, varimax rotation), Cronbach’s α for internal consistency, Pearson correlation for test–retest reliability, and Kaiser–Meyer–Olkin (KMO) and Bartlett’s test for sampling adequacy. Data were analyzed using SPSS version 29.0. Ethical approval was obtained. Written informed consent was obtained from all participants. The primary outcomes were internal consistency (Cronbach’s α), test–retest reliability (Pearson r), and construct validity assessed through EFA. Results The EMSS-PK demonstrated good internal consistency (Cronbach’s α = 0.75) and strong test–retest reliability (r = 0.90, P < .001). KMO = 0.79 and Bartlett’s test of sphericity (χ2 (105) = 816.20, P < .001) confirmed sampling adequacy. EFA identified a six-factor solution communication, conflict resolution, affection, sexual relationship, financial management, and relationship ideals accounting for 69.4% of total variance, consistent with the original EMSS theoretical framework. Cultural adaptation involved minor surface-level wording modifications to ensure conceptual equivalence without altering item meaning. Discussion The EMSS-PK provides clinicians, psychotherapists, marital counselors, and researchers with a standardized, culturally appropriate instrument for the integrated assessment of marital satisfaction and sexual health in Urdu-speaking Pakistani populations. Strengths include a rigorous five-step translation methodology, expert panel review incorporating a religious scholar, pilot testing, and comprehensive psychometric evaluation. Limitations include a convenience sample restricted to married men with sexual dysfunction from a single city, a cross-sectional design, potential social desirability bias, and the absence of confirmatory factor analysis and inter-rater reliability (ICC) assessment; generalizability to women and community-based populations requires further study. Overall, the EMSS-PK shows preliminary evidence of validity, reliability, and cultural sensitivity for measuring marital satisfaction in Urdu-speaking Pakistani populations. It is among the first Urdu marital satisfaction scales to undergo initial psychometric evaluation can advance marital counseling, sexual health intervention, and research in South Asian contexts.
