Interdisciplinary sexual rehabilitation in women and men: pelvic floor phenotyping, non‑pharmacological interventions and emerging trends—proposal of a clinical algo-rithm (narrative review)

Abstract

Starting point: Sexual dysfunctions in women and men are common, substantially impair quality of life, and frequently coexist with pelvic floor dysfunction, pain, LUTS, and psychosocial factors. In routine practice, care is often fragmented and lacks a unified rehabilitation pathway.

Aim: To propose a clinically applicable algorithm of interdisciplinary sexual rehabilitation focused on pelvic floor phenotype and non-pharmacological interventions.

Methods: This article is a narrative review with systematic elements. The literature search was performed in PubMed/MEDLINE, Scopus, the Cochrane Library, and PEDro, with supplementary screening of professional guidelines and reference lists of key papers. The search focused on adult populations and on the topics of sexual rehabilitation, pelvic floor, pelvic floor muscle training, dyspareunia, chronic pelvic pain, erectile dysfunction, genitourinary syndrome of menopause, biofeedback, shockwave therapy, and magnetic stimulation, preferably within 2015–2025; older papers were included when conceptually essential. Guidelines, systematic reviews, meta-analyses, and clinically relevant studies were prioritized; irrelevant, duplicate, and purely technical reports without direct clinical implications were excluded.

Results: We propose a practical framework including minimal baseline assessment, pelvic floor phenotyping, and phenotype-driven multimodal interventions. Core components are education, adherence support, PFMT for hypotonic phenotypes, and down-training, relaxation, and myofascial techniques for hypertonic phenotypes. Device-based methods may be considered in selected indications, but only with explicit acknowledgment of limited certainty of evidence and with informed consent.

Conclusions: A phenotype oriented interdisciplinary approach may improve targeting of rehabilitation and coordination of care. However, the proposed algorithm has not yet been empirically validated; it should be understood as an expert conceptual proposal derived from a narrative evidence synthesis and requires future prospective validation in clinical practice.