Comparative effectiveness of motivational interviewing versus pelvic floor muscle training on sexual function in women with endometriosis: an active-controlled randomized trial

Endometriosis profoundly impairs sexual function in women. Despite evidence supporting motivational interviewing (MI) and pelvic floor muscle training (PFMT) separately, no study has directly compared these two approaches on sexual function in endometriosis. This trial compared the effectiveness of MI versus PFMT on sexual function in women with endometriosis. This parallel-group, active-controlled randomized trial was conducted at Baghaeipour Clinic, Yazd, Iran (October 2024 – April 2025). Sixty women with endometriosis (30 per group) were randomly assigned to six weekly 90‑minute sessions of MI or PFMT delivered virtually. Both groups received routine care including lubricant gel. Sexual function was measured using the Female Sexual Function Index (FSFI) at baseline (T0), immediately post‑intervention (week 6, T1), and two months after intervention completion (week 14, T2). Data were analyzed using independent t‑tests, Chi‑square tests, and repeated‑measures ANOVA. Fifty‑four participants (27 per group) completed the study. Both groups were homogeneous at baseline. In the MI group, mean FSFI scores improved from baseline to T1 (17.82 ± 6.80 to 22.07 ± 7.41, p < 0.001) and to T2 (26.10 ± 3.35, p < 0.001), with sustained improvement from T1 to T2 (p < 0.001). In the PFMT group, scores improved from baseline to T1 (17.07 ± 6.04 to 23.43 ± 5.28, p < 0.001) and to T2 (24.30 ± 5.62, p < 0.001), but the T1‑to‑T2 change was not significant (p = 0.466). No significant between‑group differences were found at any time point (p > 0.05). Time had a significant effect (p < 0.001), but neither group (p = 0.880) nor time‑group interaction (p = 0.418) was significant. Both motivational interviewing and pelvic floor muscle training were associated with improved sexual function in women with endometriosis. No statistically significant difference was observed between the interventions. Both approaches offer non-invasive, complementary options for managing endometriosis-related sexual dysfunction, though further large-scale research is needed to confirm these findings and establish comparative long-term efficacy. This research was registered in the Iranian Registry of Clinical Trials (IRCT20240623062218N1) on 2024-09-14. Endometriosis can negatively affect sexual health and quality of life. This study compared two non-drug approaches, motivational interviewing (MI) and pelvic floor muscle training (PFMT), to improve sexual function in women with endometriosis. Sixty women were randomly assigned to receive six weekly online sessions of either MI or PFMT. Sexual function was assessed at baseline, immediately after the six-week intervention, and at the two-month follow-up. Fifty-four women completed the study. Sexual function improved significantly over time in both groups. However, there was no significant difference between the two interventions, and neither approach was shown to be superior. These findings suggest that both MI and PFMT may be feasible and useful complementary approaches for managing sexual dysfunction related to endometriosis. Larger studies with longer follow-up and appropriate control groups are needed to confirm these findings.