Strengthening arm, leg and trunk muscles could make sex less painful and more enjoyable for women with polycystic ovary syndrome, a small Brazilian study finds.

Physical changes, better mood and reduced anxiety are credited with the improvements in sexual function and reduced pain among women with the hormonal disorder, according to the researchers.

“It is an important study because few studies examine women’s sexuality and because it raises questions about the role of exercise in depression, anxiety and sexual functioning,” said Dr. Katherine Sherif, who directs Jefferson Women’s Primary Care at Thomas Jefferson University in Philadelphia, PA, but was not involved in the study.

Researchers included normal-weight and overweight women in the study, noting that weight problems are common with the disorder, known as PCOS, and a source of mental health problems that could affect sexual function.

“It is the first study to show that resistance training (as opposed to aerobic exercise) improved several aspects of sexuality in obese women with PCOS compared to overweight women without PCOS,” Sherif said.

PCOS affects between 5 and 10 percent of fertile-age women, according to the U.S. National Institute of Child Health and Human Development. Its cause is unknown, but may include genetic factors because the condition tends to run in families. Symptoms of PCOS are caused by an excess of “male” hormones, known as androgens, and often unusually low levels of estrogen.

Symptoms include unpleasant physical changes, including excessive hair growth, acne, seborrhea, hair loss, obesity and fat distribution along the trunk and upper body, Dr. Lucia Alves Silva Lara and her team note in the Journal of Sexual Medicine.

The study team points out that past research has found women with PCOS often have low self esteem because of their altered appearance and may have problems with their sexual function, including pain with intercourse.

Past research has also shown that physical resistance training has helped boost weight loss, physical strength, self image, health, as well as sexual function, in women with other health problems, the researchers add.

For this study, 43 women with PCOS and 51 without the condition were recruited. The average body mass index, a measure of weight relative to height, in women with PCOS was in the overweight range, with waist circumferences averaging 81 centimeters (about 33 inches). In the comparison group, body mass was slightly lower but still in the overweight range, with waist circumferences averaging 76 cm (about 31 inches).

Both groups of women participated in a 16-week exercise regimen that included stretching and using bench presses, extensor benches and other physical resistance equipment to work out hip, leg, arm and trunk muscles. Intensity of the resistance exercises rose weekly, while repetitions decreased, as the program progressed.

The women answered questions about sexual function, including desire, excitement, lubrication, orgasm, satisfaction and pain, as well as anxiety and depression, at the beginning of the program and again after 16 weeks.

Those with PCOS scored higher on sexual function and felt significantly more desire, excitement, lubrication and less pain after 16 weeks than they had at the start. They also had higher levels of desire than the women without PCOS.

The comparison group had significant decreases in pain, after the exercise regimen. And both groups of women had lower rates of anxiety and depression.

Sherif, who started the first academic program on PCOS in 2000 at Drexel University in Philadelphia, noted that the decrease in anxiety and depression, as well as the shared exercise experience, made it difficult to attribute improvements in sex to the exercise alone.

“Exercise helps improve mood, whether or not a woman has PCOS,” Sherif said, in an email to Reuters Health. “Improvement in mood, in turn, no doubt improves sexual functioning. However, resistance training, which increases lean muscle mass, is more likely to help overcome insulin resistance compared to aerobic exercise.”

The authors say more study is needed to confirm their results and pinpoint the best type of exercises and appropriate duration of exercising. Sherif said a randomized trial would help.

“A randomized trial in which women were assigned to either an exercise class or just given a list of exercises (or met as a support group) would have been possible and certainly ethical,” said Sherif. “It would help isolate the factors that improved sexual functioning and mood . . . is it being part of a group that helps, or is it the exercise that helps?”