The Longitudinal Impact of Prenatal Pilates on Female Sexual Function and Sexual Distress During Pregnancy

Pregnancy is accompanied by substantial physiological, hormonal, and psychosocial changes that may influence female sexual function and contribute to increased sexual distress. Alterations in body image, fatigue, hormonal fluctuations, and emotional well-being during pregnancy have been associated with decreased sexual desire, arousal, and satisfaction. Despite the high prevalence of sexual dysfunction during pregnancy, this topic remains under-discussed in routine antenatal care.

Physical activity during pregnancy has been associated with multiple maternal benefits, including improved musculoskeletal function, reduced stress, and enhanced quality of life. Prenatal Pilates is a low-impact exercise modality that focuses on posture, breathing, pelvic floor muscle activation, core stabilization, and flexibility. It is commonly practiced by pregnant women and is considered safe when performed under the supervision of a certified instructor. While prenatal Pilates has been shown to improve physical comfort and psychological well-being, evidence regarding its association with female sexual function and sexual distress during pregnancy remains limited.

This study is designed as a prospective observational cohort study conducted at a single tertiary care center. Pregnant women with singleton pregnancies will be enrolled during the first trimester and followed longitudinally throughout pregnancy. Participants will be categorized into two groups based on their self-reported exercise behavior: those who regularly participate in instructor-led prenatal Pilates and those who do not engage in structured exercise during pregnancy. No exercise intervention or behavioral modification will be introduced as part of the study protocol.

Data will be collected using validated, self-administered questionnaires delivered through secure online platforms during the first, second, and third trimesters of pregnancy. Female sexual function will be assessed using the Female Sexual Function Index (FSFI), a 19-item instrument evaluating six domains of sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. Sexual distress will be measured using the Female Sexual Distress Scale-Revised (FSDS-R), a 13-item questionnaire assessing sexually related personal distress. Higher FSFI scores indicate better sexual function, whereas higher FSDS-R scores reflect greater sexual distress.

Demographic and obstetric characteristics, including maternal age, parity, gestational age, and relevant medical history, will be collected at baseline. The primary objective of the study is to evaluate longitudinal changes in FSFI and FSDS-R scores across pregnancy. Secondary objectives include comparing temporal patterns of sexual function and distress between the prenatal Pilates and non-exercising groups.