The Impact of Relaxation Massage on Ovulation and Sexual Appetite

1. Introduction

Massage therapy, an ancient therapeutic practice, has been widely employed to enhance physical and mental well-being through the stimulation of circulation, muscular relaxation, and stress reduction. In recent years, research has increasingly focused on its applications in reproductive health, utilizing massage as a complementary intervention to support fertility and hormonal balance. Among its numerous benefits, the potential role of massage in inducing ovulation requires further exploration.

The practice of massage has its origins in ancient civilizations, where it served both therapeutic and cultural purposes [1,2,3,4]. In Ancient Egypt, hieroglyphics discovered in tombs indicate that massage was a significant component of healing practices, performed by skilled practitioners to relieve pain and promote relaxation [1]. Traditional Chinese Medicine, with texts dating back to 3000 B.C., describes techniques such as Tui Na, which focuses on manipulating energy (Qi) and enhancing blood flow to restore health [2]. In Ancient Greece and Rome, figures like Hippocrates endorsed massage as a method to improve health and treat ailments, while the Romans integrated it into their daily lives, using it in baths and spas for relaxation and recovery [3]. Ayurveda in India has also incorporated massage for centuries, emphasizing its role in balancing the doshas (bodily energies) and fostering overall well-being [4].

General benefits of massage

Massage therapy offers a diverse array of benefits for overall health, which include:

Improvement of blood circulation: massage facilitates increased blood flow throughout the body, particularly to the reproductive organs. Enhanced circulation ensures an augmented supply of oxygen and essential nutrients to the ovaries, uterus, and other structures critical for reproductive function [5,6].

Reduction of muscular tension and relaxation of the body: by alleviating muscular tension and mitigating stress, massage contributes to the homeostasis of the nervous system, which can positively influence hormonal equilibrium. Elevated stress levels have been documented to adversely affect the menstrual cycle and ovulation [5,6].

Stimulation of lymphatic drainage: massage promotes lymphatic drainage, aiding in the expulsion of toxins and metabolic waste from the body, thereby fostering an optimal environment for reproductive functions [6,7].

Hormonal regulation: abdominal massage and fertility-specific techniques can stimulate natural hormonal processes, encouraging the production of hormones involved in ovulation, such as estrogen and progesterone. Through targeted massage techniques, the flow of energy and blood in the abdominal region may sustain hormonal balance [8,9].

Fertility massage and ovulation induction

Fertility massage represents a specialized form of manual therapy that concentrates on the lower abdomen, ovaries, uterus, and other reproductive structures. Its primary objectives are to enhance the health of the reproductive system, optimize its functionality, and promote the natural ovulation process. Specific techniques include:

Deep abdominal massage: this technique is employed to enhance pelvic circulation and release tension in the connective tissues surrounding the uterus and ovaries. Such interventions may create a conducive environment for ovulation [7].

Maya abdominal therapy: this traditional Mayan technique focuses on the repositioning of abdominal and pelvic organs, which, if misaligned, can adversely affect fertility. Its aim is to restore the proper alignment of organs and improve blood and lymphatic flow, thereby supporting ovulation [9].

Acupressure: when combined with massage, acupressure—applying targeted pressure to specific acupoints—may stimulate the endocrine system and promote the release of hormones essential for ovulation induction.

Reflexology: this practice involves the stimulation of specific reflex points located on the feet and hands, associated with reproductive organs. Reflexology may assist in balancing the body’s energy and supporting a regular menstrual cycle [8,9].

Impact of massage on fertility

A growing body of literature suggests that massage therapy, through stress reduction and enhanced circulation, may support fertility, particularly in women facing conception difficulties attributed to ovulatory dysfunction. While massage may not universally induce ovulation, it serves as a valuable adjunct in the promotion of reproductive health, particularly when integrated with other therapeutic modalities and medical interventions [7,8,9].

Additional benefits of massage in reproductive health

Fertility massage, in addition to its potential role in facilitating ovulation, may offer several important benefits [7,9]. Abdominal massage has been shown to improve uterine tone and help prevent complications such as a tilted uterus or inadequate blood flow to the region [7,9]. Women experiencing severe dysmenorrhea may find relief through abdominal massage, which promotes muscle relaxation and alleviates cramping [9]. Massage therapy may also assist women postpartum by helping to restore hormonal balance and supporting the recovery of overall reproductive health [8]. Although there is limited conclusive evidence for massage as a sole method for inducing ovulation, its integration into a broader reproductive health strategy—including balanced nutrition, regular physical activity, and stress management—may enhance the likelihood of successful conception [7,8,9].

2. Materials and Methods

This prospective study was conducted at the Santerra Medical Center, Constanta, Romania. It aimed to monitor ovulation in a cohort of 70 patients, aged between 19 and 35 years, seeking fertility assessment for conception purposes. The study lasted three months, allowing for a detailed evaluation of hormonal responses and ovulation.

The study was approved by Santerra Medical Center Ethical Committee (approval no.002, 17 January 2024) and complied with the revised ethical guidelines of the Declaration of Helsinki. All patients entered into the study agreed to participate and signed an informed consent form after all the risks and benefits of the therapy were explained to them. They had the opportunity to stop participating at any time and their data was confidential.

Pregnant patients, menopausal patients, or patients using antidepressant, ovulation-inducing, contraceptive, or any type of hormonal or nonhormonal medication that could have influenced ovulation were not included in the study. Eight patients who became pregnant during the study were excluded from the study and 2 patients chose to withdraw from the study with their own consent.

The cohort consist of 60 patients, who have chosen to monitor ovulation using the combined method that included:

Transvaginal ultrasound: each patient underwent transvaginal ultrasound immediately after menstruation (day 5 of the menstrual cycle) and on day 12 after menstruation. These evaluations allowed for the observation of ovarian follicles and estimation of the timing of ovulation.

Urinary ovulation tests: from day 10 to day 16 of the menstrual cycle, patients performed urinary ovulation tests every morning upon waking. These tests were used to determine the concentration of luteinizing hormone (LH), which indicates the approach of ovulation.

Among the 60 patients, the 32 patients in the corresponding subgroup agreed to participate in relaxation massage sessions, scheduled twice a week throughout the entire monitoring period. These sessions aimed to reduce stress and create a conducive environment for ovulation.

The 28 patients in the other subgroup were monitored monthly for ovulation using urinary ovulation tests and transvaginal ultrasound but did not participate in the massage interventions. The results of the two subgroups were compared to assess the impact of relaxation massage on ovulation monitoring and conception rates.

Patients in the corresponding subgroup agreed to participate in relaxation massage sessions,, at the end of the study period, filled out a form in which they were asked if the relaxation massage had any influence on their sexual performance and to what extent: important, moderate, mild or no result in increasing the sexual appetite.

Data Analysis

The statistical analysis was performed using IBM SPSS version 23. Data are presented as mean ± standard deviation (SD) for continuous variables in cases of symmetric distributions. The normality of the continuous data was estimated with Shapiro–Wilk Tests of Normality. For hypotheses testing: Independent Samples Median test, t-Student Test and Chi-Square Test of association were used depending on the type of analyzed variables. The significance level α was set at 0.05. If the test statistics for every test conducted was in the critical region and the p-value was less than or equal to the significance level, we decided to reject the null hypothesis in favor of the alternative hypothesis. In the Discussions section, we presented the p-statistic and the confidence interval only where they had an important statistical significance in terms of our observations and future conclusions.

3. Results

Among the 28 patients monitored without the addition of ovulation-inducing massage, 57,14% exhibited regular monthly ovulation as confirmed by cross-validated testing, while 42,85% did not ovulate consistently each month. Of these 12 patients, 58,33% showed anovulation over the entire 3-month period, and 41,66% demonstrated intermittent ovulation. In contrast, of the 32 patients who incorporated ovulation-inducing massage, 75% achieved consistent monthly ovulation, while 25% did not ovulate monthly. Among the latter group, 25% did not ovulate throughout the entire 3-month period, and 75% showed intermittent ovulation (Table 1).

This table emphasizes that the group receiving ovulation-inducing massage had a higher number of patients with consistent monthly ovulation compared to the group without massage.

In the group of 32 patients who practiced relaxation massage, 37.5% reported a significant increase of sexual appetite, 31.25% a moderate increase, 25% a slight increase. Only 6.25% of patients reported no modifications of sexual appetite (Table 2).

This table emphasizes that the group receiving relaxing massage had an important effect in increasing sexual appetite. 37.5% of the patients reported a significant increase in sexual appetite, 31.5% a moderate increase and 25% a slight increase during the relaxation massage.

4. Discussion

The results of our study indicate a notable difference in the proportion of women experiencing monthly ovulation between the two groups. Specifically, 75% of women in the massage group achieved ovulation monthly, compared to only 57.1% in the control group that did not receive massage therapy (p<0.05, CI 95%) (Table 1). This suggests that ovulation-inducing massage may enhance ovulatory function by increasing blood flow to the ovaries and uterus. Improved circulation facilitates the delivery of oxygen and essential nutrients necessary for follicle development [10]. Furthermore, massage has been shown to lower cortisol levels, which can mitigate stress and potentially stabilize the hypothalamic-pituitary-ovarian axis, a crucial regulator of ovulation [11,12]. Additionally, the technique promotes lymphatic drainage, aiding in the elimination of toxins that may impair reproductive health, and may assist in realigning pelvic organs to improve overall blood flow and functionality [13].

Moreover, we observed a higher proportion of women with intermittent ovulation in the massage group (18.7%) compared to the control group (17.8%) (Table 1). This suggests that massage may affect inducing ovulation, particularly among women with anovulatory cycles or mild polycystic ovarian syndrome. Notably, the percentage of women who did not ovulate at all was lower in the massage group, indicating a possible therapeutic benefit.

Numerous studies support the positive effects of massage therapy across various health conditions. For instance, a review conducted by Liu et al. (2015) discusses the applicability of diverse massage techniques in treating numerous ailments, yielding significant results in the realms of neoplastic disorders, inflammatory diseases, spinal pathologies, and as an adjunct to psychological therapy [14]. Furthermore, studies on the prevalence of women seeking therapeutic massage highlight a higher percentage of younger and middle-aged women compared to older women, with a noted decrease in referrals to physiotherapy centers among patients with chronic conditions such as hypertension and diabetes [15].

The massage for pregnant women has been controversial for a long time. Some authors considered that the harder massage techniques applied to pregnant women can induce premature birth or even premature detachment of the normally inserted placenta. Abdominal traumas, even of low intensity, are incriminated as etiological factors of placental abruption [16]. However, some studies consider that abruptio placentae occurs due to important changes in the morphology of the placental vascularization [17].

The Covid-19 pandemic represented an important challenge, both for obstetrics-gynecology doctors and for physiotherapists. Many cases associated with gynecological pathology, especially adnexal, were underdiagnosed or even undiagnosed due to the conditions imposed by social isolation [18]. Also, during that period, the physiotherapy centers recorded a historic minimum in terms of the number of patients.

Various massage techniques have been shown to positively influence sexual function, quality of life, and self-esteem. In our study, 68.75% of patients reported significant or moderate increases of sexual appetite (p<0.05, CI 95%) (Table 2). A study reported significant improvements in these parameters through therapies involving transverse friction and Thiele massage, which also impacted symptoms related to the lower urinary tract [19]. Regarding gynecological pathology, numerous studies illustrate the therapeutic adjunct effects of different massage types in alleviating premenstrual syndrome symptoms, particularly reducing cramps [20,21]. Techniques involving massage in conjunction with aromatherapy have also been reported to decrease the severity of pain associated with primary dysmenorrhea [21,22,23]. Additionally, foot massage has been found to reduce sexual distress and enhance sexual self-confidence among women experiencing sexual difficulties, suggesting its utility in improving sexual health [24].

The effects of Ayurvedic treatment protocols on diminishing ovarian reserve demonstrated statistically significant improvements in parameters such as antral follicle contain, estradiol levels, conception rates, and menstrual regulation. However, no significant effects were noted on Anti-Müllerian Hormone levels or regularizing LH/FSH ratios [25].

Aromatherapy utilizing Rosa damascena was effective in reducing pain and anxiety during the first stage of labor among nulliparous women. The findings suggest that aromatherapy with Rosa damascena presents a convenient and effective method for alleviating discomfort during labor [26].

Additionally, animal studies indicate that ovarian massage during the luteal phase may shorten the length of the estrous cycle and induce earlier ovulation. It was concluded that clitoral massage reduced the incidence of prolonged estrus in cows, suggesting a management strategy to decrease the need for double artificial insemination (AI) and the number of AI per conception in herds experiencing prolonged heat and service failures [27,28].

Although the literature indicates that approximately 80-90% of women ovulate monthly, our study revealed an ovulation rate of only 57.1% [29]. This discrepancy may be attributed to factors such as age, nutrition, overall health status, and gynecological conditions like polycystic ovary syndrome [30,31,32]. Massage therapy can be successfully recommended as a method of postoperatively recuperation in patients that undergone ovarian classic or laparoscopic surgery or cases associated with endometriosis, especially in those with a reduced ovarian reserve, as well as patients with cardiovascular affections improving the overall quality of life [33,34,35].

Nonetheless, the incorporation of massage therapy demonstrated a significant effect on inducing ovulation and increasing of sexual appetite as evidenced by the data from our study.

5. Conclusions

We emphasize the importance of massage in enhancing conception rates through its multiple benefits, including stress reduction, ovulation induction, sexual appetite increases and improvement of local normotrophy. These findings highlight the potential of integrative approaches, such as massage therapy, in supporting reproductive health and fertility.