Mediterranean-style diets improve pelvic floor function and sexual health, review finds

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Oct 19 2025

A major review shows that what we eat may significantly influence pelvic floor outcomes, offering new hope for improving sexual function and incontinence through dietary intervention rather than solely physical therapy or medication.

Review: Healthy dietary patterns improve sexual function and incontinence symptoms: systematic review and meta-analysis of dietary patterns and dietary interventions. Image Credit: Oksana Mizina / Shutterstock

In a recent systematic review and meta-analysis published in the journal Frontiers in Nutrition, researchers collated and reanalyzed scientific data from 31 studies to investigate the role of dietary interventions in pelvic floor dysfunction (PFD) outcomes, including sexual dysfunction and incontinence. The review aimed to address this rising global concern, potentially improving the quality of life (QoL) for millions.

Review findings revealed that healthy, anti-inflammatory dietary patterns, particularly the Mediterranean diet, are significantly associated with improved sexual function and reduced incontinence symptoms, while pro-inflammatory diets were linked to increased PFD risk.

Background

Pelvic floor dysfunction (PFD) is an umbrella term for a complex set of conditions (e.g., sexual dysfunction and incontinence) and is an anatomical condition characterized by weak, damaged, or uncoordinated muscles in the pelvic floor, leading to urinary or fecal incontinence, pelvic pain, constipation, and pelvic organ prolapse.

PFD is an unexpectedly globally prevalent condition often hidden by social stigma. Its symptoms, including urinary or fecal incontinence, pelvic organ prolapse, and sexual dysfunction, such as erectile dysfunction in men or orgasmic dysfunction in women, can significantly impair patients’ QoL, often requiring clinical interventions to improve outcomes and restore functional normalcy.

While lifestyle modifications are often leveraged as the first-line treatment in addressing PFD diagnoses, the conversation surrounding these interventions has historically been dominated by physical therapies (e.g., Kegel exercises). However, a growing body of literature suggests that diet may play a pivotal role, given its link to chronic inflammation and metabolic health. Notably, anti-inflammatory diets have previously been linked to better sexual function, while high salt intake is known to worsen overactive bladder symptoms.

Unfortunately, despite these hypotheses, clinical investigations of the topic remain fragmentary, often focusing on single nutrients rather than the synergistic effects of whole dietary patterns. Consequently, a large-scale, systematic synthesis is needed to understand the true impact of diet on PFD.

About the Review

The present systematic review and meta-analysis aim to address this knowledge gap and inform future PFD interventions by synthesizing all high-quality existing evidence on the topic. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a gold standard for such reviews.

The review comprised a thorough, custom search-directed scrutiny of several public scientific repositories (e.g., PubMed, Web of Science, and Embase) for studies published up to August 2024 (total identified = 493). Studies were screened (title, abstract, and full text) to identify those meeting review criteria and targeted five evidence-based dietary patterns: the Mediterranean diet, the DASH diet, the healthful Plant-Based Diet Index (hPDI), and both anti-inflammatory and pro-inflammatory diets (total screening and selected = 31).

Notably, 14 studies (eight cross-sectional studies, three prospective studies, and three randomized controlled trials [RCTs]) provided sufficient quantitative data to be pooled into a new meta-analysis, allowing for the statistical calculation of the overall effect of these diets on sexual function and incontinence symptoms.

Review Findings

The present systematic review elucidates clear and compelling evidence linking diet and pelvic floor health. Overall, healthy dietary patterns were associated with significant improvements in both sexual dysfunction and incontinence symptoms.

When independently analyzing sexual dysfunction, both the Mediterranean diet and general anti-inflammatory diets were significantly associated with a reduced risk. The pooled data from cross-sectional studies showed that healthy diets reduced the odds of sexual dysfunction (OR = 0.69). Data from prospective studies reinforced these findings, demonstrating a significant improvement in sexual function scores (Standardized Mean Difference, SMD = -0.60). However, high statistical heterogeneity was observed among prospective studies (I² = 87%), prompting a sensitivity analysis. When two Esposito trials were excluded, the effect remained positive but more modest (SMD = -0.25), indicating greater consistency. Benefits were most pronounced in individuals with metabolic syndrome, suggesting that endothelial and inflammatory mechanisms may play a key role. The hPDI did not consistently show improvement, indicating that diet quality alone may not guarantee benefit without anti-inflammatory properties.

When analyzing incontinence data, results were more nuanced. Pro-inflammatory diets (high Dietary Inflammatory Index scores) were strongly associated with increased urinary and fecal incontinence risk. The cross-sectional data confirmed that adhering to a less inflammatory diet reduced the odds of incontinence (OR = 0.77, p < 0.0001). The DASH diet was also shown to be effective in alleviating lower urinary tract symptoms, an observation attributed to the diet’s low salt content. However, in prospective analyses, the overall effect on incontinence was not statistically significant (SMD = -0.17), suggesting that improvements may be mediated through weight loss and reductions in intra-abdominal pressure rather than direct inflammatory pathways.

Conclusions

The present systematic review and meta-analysis provide the most robust information to date that healthy, anti-inflammatory diets, especially the Mediterranean diet, can serve as a valuable tool in managing pelvic floor dysfunction. The findings strongly support integrating dietary counseling into clinical practice for PFD, particularly for patients who also have metabolic risk factors like obesity or type 2 diabetes (T2D). However, the authors emphasize that most included studies were observational, limiting causal inference, and residual confounding, especially from BMI, cannot be excluded.

While the observational nature of many included studies and variations in their design limit the causation and generalizability of the review, it provides a strong scientific basis for recommending diet as a non-pharmacological strategy to improve pelvic floor health.