Effectiveness of physiotherapy alone or combined with medical treatment compared to medical treatment only in the management of genitourinary syndrome of menopause in women with urinary incontinence and/or sexual dysfunction: a systematic review

Introduction Genitourinary Syndrome of Menopause (GSM) is prevalent among peri- and postmenopausal women and is associated with urinary symptoms, sexual dysfunction, and reduced quality of life. Although medical treatments are widely used, the contribution of physiotherapy, alone or combined with medical therapies, remains insufficiently defined.Methods A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched from January 2015 to April 2025. Studies evaluating physiotherapy-based interventions, either alone or combined with medical treatments, in women with GSM were included. Outcomes assessed urinary symptoms, pelvic floor muscle function, sexual function, vaginal health, and quality of life. Methodological quality was assessed using the PEDro scale.Results Eleven studies were included. Interventions comprised pelvic floor muscle training, biofeedback, radiofrequency, Pilates-based exercise, and visceral manipulation. Most studies reported improvements in urinary symptoms and pelvic floor muscle function, while effects on sexual and vaginal outcomes were inconsistent. Some studies suggested additional benefits with combined interventions, although protocols and outcome measures varied considerably.Conclusion Physiotherapy-based interventions may improve urinary and selected sexual health outcomes in women with GSM and may complement medical treatments. However, heterogeneity across studies limits comparability. Further high-quality randomized trials with standardized outcomes are required.