Sachi Health Can exercise improve sexual function with PCOS? After 16 weeks, both aerobic training groups crossed back above the clinical threshold
A 16-week randomized controlled trial in women with PCOS: continuous and intermittent aerobic training both raised sexual function scores past the 26.55 threshold, while anxiety, depression, and testosterone fell.
This is the same Brazilian trial we covered last week, asking a different question. Sixty-nine sexually active women with PCOS spent 16 weeks doing continuous treadmill training, intermittent treadmill training, or no exercise. Sexual function was measured with a standard six-domain questionnaire where a score above 26.55 puts you outside the range associated with sexual dysfunction. Both exercise groups started below that line and finished above it. The no-exercise group drifted slightly down. Anxiety and depression improved in both training groups, testosterone fell in both, and this time the researchers published their full week-by-week protocols, so you can see exactly what these women did.
The numbers that matter
Changes in the intermittent training group. The continuous group moved +3.1, −2.0, and −2.4 on the same three measures, and the untrained group moved −0.8, −0.5, and +0.2.
Can we actually trust this?
Yes, with one clear caveat. Randomization was handled by people outside the recruiting team using sealed envelopes, there was a real no-exercise comparison group, and the two programs were matched for total effort, so this is a fair test of format rather than of doing more. It was registered in two trial registries, publicly funded, and conflict-free. The caveat is the sample: of 110 women randomized, only 69 are in this analysis, and 18 of those left out had declined the sexual function questionnaire because it made them uncomfortable, which means the women most uneasy about the topic aren't represented. The study also fell just short of its own target sample size, and didn't track diet or how often participants were having sex. One more point of precision: intermittent training improved five of six domains and continuous improved two, but compared head to head the two were statistically equivalent, so that gap is each group measured against itself rather than against the other.
Does this apply to you?
This study is most relevant if:
- You have PCOS diagnosed by Rotterdam criteria
- You're between 18 and 39
- You're currently sedentary
- Your BMI is between 18 and 39.9
- You've been sexually active in the past six months
Like last week's issue, these women were recruited from a hospital endocrinology and infertility clinic.
Why this matters
Sexual function is one of the parts of PCOS that almost never makes it into the appointment, even though it shows up in the research over and over, tangled together with mood, body image, and hyperandrogenism. So it's genuinely good news that something as ordinary as a treadmill moved it. The questionnaire used here has a validated cutoff at 26.55, below which women are considered at increased risk of sexual dysfunction, and both exercise groups started below that line at around 25 and finished above it, at 28 and 29.9. The untrained group started just above the line and slipped below. That's a move across a clinically meaningful boundary in four months, and it happened alongside lower anxiety, lower depression, and lower testosterone. Continuous training improved satisfaction and pain; intermittent improved desire, arousal, lubrication, orgasm, and satisfaction. Last week we saw this same trial ease how women felt about their bodies without those bodies changing. This week fills in more of the same picture: weight didn't meaningfully move here either, and the things that did are the ones that determine whether you feel at home in your own life.
If you want to try this
- The continuous protocol, week by week.
Three treadmill sessions a week for 16 weeks, each with a five-minute warm-up and five-minute cool-down at 50 to 60% of maximum heart rate. Weeks 1 to 3: 30 minutes at 65 to 70% of max heart rate. Weeks 4 to 6: 35 minutes at 70 to 75%. Weeks 7 to 10: 40 minutes at 70 to 75%. Weeks 11 to 13: 45 minutes at 75 to 80%. Weeks 14 to 16: 50 minutes at 75 to 80%. Steady effort throughout, no surges.
- The intermittent protocol, week by week.
Same three sessions a week, same warm-up and cool-down. Each session is a series of intervals: two minutes at a higher intensity, then three minutes at a recovery intensity, repeated. Weeks 1 to 3: 6 rounds, 30 minutes total, working at 70 to 80% of max heart rate with recovery at 60%. Weeks 4 to 6: 7 rounds, 35 minutes, working at 80 to 85% with recovery at 60 to 65%. Weeks 7 to 10: 8 rounds, 40 minutes, working at 85% with recovery at 65 to 70%. Weeks 11 to 13: 9 rounds, 45 minutes, working at 85 to 90%. Weeks 14 to 16: 10 rounds, 50 minutes, working at 85 to 90%.
- Both were designed to be equally hard overall.
The researchers matched the two programs by multiplying heart rate elevation by session length, so neither group was doing more total work. If you're choosing between them, choose the one you'll actually keep doing.
- Expect the progression to be gradual.
Both protocols start at half an hour and add time slowly, reaching 50 minutes only in the final three weeks. Nothing here jumps.
- Give it the full 16 weeks.
Everything was measured at baseline and at week 16, with nothing in between, so there's no evidence about when these changes start to appear. A quiet first month tells you nothing.
- Keep the context in mind.
Sexual function in PCOS is tied up with hormones, mood, body image, relationships, and sometimes medication. Exercise moved the needle in this study, but if something here is troubling you, it's worth raising with a clinician who can look at the whole picture.
FAQ
- Does exercise improve sexual function in women with PCOS?
- In this trial it did. Both continuous and intermittent aerobic training raised total sexual function scores over 16 weeks, moving both groups from below the clinical threshold for sexual dysfunction to above it, while the untrained comparison group didn't improve. The sample was small and about a third of eligible women were left out of the analysis, so treat this as promising rather than proven.
- Is interval training or steady cardio better for PCOS sexual function?
- This study can't tell you. Intermittent training improved five of six domains and continuous improved two, but that's each group compared to its own baseline. Head to head, the two were statistically equivalent. The practical answer is that both worked, so the better one is the one you'll stick with.
- What is the FSFI and what does a score of 26.55 mean?
- The Female Sexual Function Index is a 19-question survey covering desire, arousal, lubrication, orgasm, satisfaction, and pain, scored from 2 to 36. A total of 26.55 or below is the validated cutoff indicating increased risk of sexual dysfunction. Both exercise groups in this study started just under that number and ended above it.
- Does exercise lower testosterone in PCOS?
- Both training groups saw testosterone fall over the 16 weeks, and the intermittent group also reduced their waist-to-hip ratio. The researchers were careful not to claim the hormone change caused the improvements in sexual function or mood, since their analysis couldn't establish that link.
How Sachi can help
This is a study about the parts of PCOS that don't get discussed, and that's exactly the gap Sachi is built around. The protocol here is concrete: three sessions a week, sixteen weeks, a specific progression. Sachi turns that into a goal you can hold onto, with your workouts flowing in from Apple Health so the sessions log themselves, and your mood and symptoms tracked alongside them.
The reason to track both at once is that this trial's findings would be invisible to you otherwise. Weight didn't move. What moved were things that live entirely in how you feel: mood, desire, comfort, satisfaction. If those are the outcomes that matter, and the research keeps suggesting they are, then you need a record of them to know whether anything you're doing is working. Some of this is live today and some is still being built. You can follow along or join the beta at sachi-health.com.
Study at a glance
Reference
Lopes IP, Ribeiro VB, Reis RM, Silva RC, de Souza HCD, Kogure GS, Ferriani RA, Lara LAS (2018). Comparison of the effect of intermittent and continuous aerobic physical training on sexual function of women with polycystic ovary syndrome: randomized controlled trial. The Journal of Sexual Medicine , 15(11), 1609-1619. https://doi.org/10.1016/j.jsxm.2018.09.002
Cite this issue
Sachi Health. (August 18, 2026). Can exercise improve sexual function with PCOS? After 16 weeks, both aerobic training groups crossed back above the clinical threshold. The PCOS Brief. https://www.sachi-health.com/blog/the-pcos-brief-issue-27
Further reading from The PCOS Brief
Kogure GS, Lopes IP, Ribeiro VB, Mendes MC, Kodato S, Furtado CLM, Silva de Sá MF, Ferriani RA, Lara LAS, dos Reis RM (2020). The effects of aerobic physical exercises on body image among women with polycystic ovary syndrome. Journal of Affective Disorders, 262, 350-358. https://doi.org/10.1016/j.jad.2019.11.025 — Read our plain-English summary.