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Jin MY, D'Souza RS, Abd-Elsayed AA. Efficacy of Neuromodulation Interventions for the Treatment of Sexual Dysfunction: A Systematic Review. Neuromodulation 2023; 26:1518-1534. [PMID: 35981957 DOI: 10.1016/j.neurom.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/11/2022] [Accepted: 07/12/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The primary aim of this review was to analyze the literature for the efficacy of neuromodulation interventions in treating both male and female sexual dysfunction. MATERIALS AND METHODS Studies were identified from PubMed, Scopus, PsychINFO, CINAHL, and Cochrane. Results were synthesized qualitatively without pooling owing to the heterogeneous nature of outcome assessments. RESULTS Overall findings from studies generally supported that neuromodulation interventions were associated with improvement in sexual function. Specific domains that improved in male patients included erectile function, desire, and satisfaction, whereas desire, arousal, orgasm, lubrication, quality of "sex life," intercourse capability, and dyspareunia improved in female patients. Male ejaculation, orgasm, and intercourse capability were the only domains that continued to decline after the use of neuromodulation interventions, although this was only reported in one study. CONCLUSION Our review suggests that there may be promise and potential utility of neuromodulation in improving sexual dysfunction; however, further research is needed.
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Affiliation(s)
- Max Y Jin
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA; Mayo Clinic, Rochester, MN, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alaa A Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA; Mayo Clinic, Rochester, MN, USA.
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Levy G, Lowenstein L. Overactive Bladder Syndrome Treatments and Their Effect on Female Sexual Function: A Review. Sex Med 2019; 8:1-7. [PMID: 31604683 PMCID: PMC7042164 DOI: 10.1016/j.esxm.2019.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction Overactive bladder (OAB), the most common subtype of urinary incontinence, has a heavy price on quality of life, especially on sexual life. Unfortunately, most women rarely voice the worsening of sexual function, especially those who already suffer from OAB symptoms. It has been demonstrated that patients who suffer from OAB score lower on Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire and Female Sexual Function Index scores, meaning that their sexual function is debilitated. Therapies for OAB begin with traditional pelvic floor physiotherapy, advance to anticholinergic drugs, and become more invasive with intravesical injections of onabotulinumtoxinA (commonly known as Botox). Last, for patients resistant to conservative therapies, sacral neuromodulation is the treatment of choice. Methods This article reviews the current literature that sheds light on the above 4 treatments and their effect on sexual function. This topic is of great importance because of the under-reporting of sexual dysfunction in women who suffer from OAB, in hopes of raising awareness of sexual function for clinicians treating patients with OAB. Results This review found that the aforementioned 4 treatments for OAB (physiotherapy, anticholinergic drugs, intravesical injections of onabotulinumtoxinA, and sacral neuromodulation) do not have a detrimental affect on sexual function. On the contrary, the little data that do exist show that sexual function increases after these therapies are completed in women with OAB. Conclusion This review concludes with a positive outlook: physicians are helping women with OAB syndrome to improve their sexual function. However, not enough data exist, partially due to under-reporting of diminished sexual function. Levy G, Lowenstein L. Overactive Bladder Syndrome Treatments and Their Effect on Female Sexual Function: A Review. Sex Med 2019;8:1–7.
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Affiliation(s)
- Gali Levy
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Tel Aviv, Israel.
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
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de Oliveira PS, Reis JP, de Oliveira TR, Martinho D, E Silva RP, Marcelino J, Gaspar S, Martins F, Lopes T. The Impact of Sacral Neuromodulation on Sexual Dysfunction. Curr Urol 2019; 12:188-194. [PMID: 31602184 DOI: 10.1159/000499307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/06/2018] [Indexed: 12/26/2022] Open
Abstract
Background/Aims Sacral neuromodulation (SNM) is a well-established treatment in several urinary and bowel dysfunctions, nevertheless its role on sexual dysfunction remains unclear. We evaluate the impact of SNM on sexual function and its association with age at SNM, functional diagnosis and post-void residual urine (PVR) before SNM. Methods Patients who had SNM were retrospectively analyzed. Sexual function was assessed before and after treatment with the International Index of Erectile Function (IIEF-5) for men and the Female Sexual Function Index (FSFI) for women. IIEF-5 and FSFI were also associated with age at SNM, functional diagnosis, and PVR. Results Fifteen females and 9 males, with a median age of 41 years (26-72 years), median follow-up 20.7 months (2-53 months) were enrolled. IIEF-5 improved in 4 patients (p = 0.06), and FSFI total score in 5 (p = 0.2). There was significant association between functional diagnosis and FSFI total score (p = 0.05), and FSFI specific domains of arousal (p = 0.03), lubrication (p = 0.04), and satisfaction (p = 0.03), with significant improvement showed in patients with detrusor overactivity with impaired contractility. Conclusion Although gains observed in IIEF-5 and FSFI were modest, our preliminary results show that SNM may have favorable impact on sexual function.
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Affiliation(s)
| | - José Palma Reis
- Department of Urology, Hospital de Santa Maria, Lisbon, Portugal
| | | | - David Martinho
- Department of Urology, Hospital de Santa Maria, Lisbon, Portugal
| | | | - Joao Marcelino
- Department of Urology, Hospital de Santa Maria, Lisbon, Portugal
| | - Sandro Gaspar
- Department of Urology, Hospital de Santa Maria, Lisbon, Portugal
| | | | - Tome Lopes
- Department of Urology, Hospital de Santa Maria, Lisbon, Portugal
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Khunda A, McCormick C, Ballard P. Sacral neuromodulation and sexual function: a systematic review and meta-analysis of the literature. Int Urogynecol J 2018; 30:339-352. [PMID: 30535791 DOI: 10.1007/s00192-018-3841-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/28/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Sexual function is being increasingly recognized as an important patient-reported outcome. Sacral neuromodulation (SNM) is a treatment with an expanding list of indications. The effect of sacral neuromodulation on sexual function has been examined in a number of studies with variable results. In this review, we aim to systematically review the literature and pool the data if appropriate. METHODS The literature search was conducted primarily on the Healthcare Databases Advanced Search (HDAS) platform using the Medline, EMBASE and CINHAL search engines. Of 196 initial citations, 17 articles met our predefined inclusion criteria. Thirteen studies reported enough information to be included in our meta-analysis. RevMan5 software was used for analysis. RESULTS Eight of 17 studies reported a positive effect of SNM on sexual function. Pooled analysis of data from 11 studies involving 573 patients before SNM and 438 patients after SNM showed significant improvement in sexual function (SMD = -0.39; 95% CI: -0.58 to -0.19; p = 0.0001). The results remained significant in most subgroup analyses except in patients suffering from fecal incontinence. CONCLUSIONS SNM in women with pelvic floor disorders, especially bladder dysfunction, seems to have a positive effect on sexual function. This needs to be verified in adequately powered primary research using sexual function as the primary outcome.
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Affiliation(s)
- Aethele Khunda
- James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
| | | | - Paul Ballard
- James Cook University Hospital, Middlesbrough, TS4 3BW, UK
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Zimmerman LL, Gupta P, O'Gara F, Langhals NB, Berger MB, Bruns TM. Transcutaneous Electrical Nerve Stimulation to Improve Female Sexual Dysfunction Symptoms: A Pilot Study. Neuromodulation 2018; 21:707-713. [PMID: 30247794 DOI: 10.1111/ner.12846] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/11/2018] [Accepted: 07/15/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To perform a pilot study using transcutaneous electrical nerve stimulation (TENS) on the dorsal genital nerve and the posterior tibial nerve for improving symptoms of female sexual dysfunction (FSD) in women without bladder problems. We hypothesize that this therapy will be effective at improving genital arousal deficits. MATERIALS AND METHODS Nine women with general FSD completed the study. Subjects received 12 sessions of transcutaneous dorsal genital nerve stimulation (DGNS; n = 6) or posterior tibial nerve stimulation (PTNS; n = 3). Stimulation was delivered for 30 min at 20 Hz. Sexual functioning was evaluated with the female sexual functioning index (FSFI), and surveys were also given on general health, urological functioning, and the Patients' Global Impression of Change (PGIC) after treatment. Surveys were given before treatment (baseline), after 6 and 12 weeks of treatment, and 6 weeks after the completion of stimulation sessions. RESULTS The average total FSFI score across all subjects significantly increased from 15.3 ± 4.8 at baseline to 20.3 ± 7.8 after six sessions, 21.7 ± 7.5 after 12 sessions, and 21.3 ± 7.1 at study completion (p < 0.05 for all time points). Increases were observed in both DGNS and PTNS subjects. Significant FSFI increases were seen in the subdomains of lubrication, arousal, and orgasm, each of which is related to genital arousal. Bladder and general health surveys did not change across the study. PGIC had a significant increase. CONCLUSIONS This study provides evidence that transcutaneous stimulation of peripheral nerves has the potential to be a valuable therapeutic tool for women with FSD.
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Affiliation(s)
- Lauren L Zimmerman
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Florence O'Gara
- Sexual Health Counseling, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas B Langhals
- Department of Surgery, Plastic Surgery Section, University of Michigan, Ann Arbor, MI, USA
| | - Mitchell B Berger
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.,Obstetrics & Gynecology, Main Line Health, Wynnewood, PA, USA
| | - Tim M Bruns
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
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Tahseen S. Role of sacral neuromodulation in modern urogynaecology practice: a review of recent literature. Int Urogynecol J 2018; 29:1081-1091. [PMID: 29302716 DOI: 10.1007/s00192-017-3546-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/12/2017] [Indexed: 12/01/2022]
Abstract
Sacral neuromodulation (SNM) offers promise in the therapy of many pelvic floor disorders. This innovative treatment has slowly gained popularity. A review of recent literature is presented in relation to its efficacy and complications in various pelvic floor conditions: overactive bladder and urge urinary incontinence, chronic urinary retention, painful bladder syndrome, pelvic pain and double incontinence. It is a minimally invasive, completely reversible safe procedure with good long-term outcomes. However, the treatment is costly, the revision rate is high and patients require life-long follow-up. SNM should always be considered in suitable patients before offering bladder augmentation procedures or urinary diversion or permanent catheterization for bladder dysfunction. SNM should also be considered in patients with double incontinence, after discussion in a urogynaecology/colorectal multidisciplinary team.
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Rice IC, Zimmerman LL, Ross SE, Berger MB, Bruns TM. Time-Frequency Analysis of Increases in Vaginal Blood Perfusion Elicited by Long-Duration Pudendal Neuromodulation in Anesthetized Rats. Neuromodulation 2017; 20:807-815. [DOI: 10.1111/ner.12707] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/15/2017] [Accepted: 09/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Indie C. Rice
- Department of Biomedical Engineering; University of Michigan; Ann Arbor MI USA
- Biointerfaces Institute; University of Michigan; Ann Arbor MI USA
| | - Lauren L. Zimmerman
- Department of Biomedical Engineering; University of Michigan; Ann Arbor MI USA
- Biointerfaces Institute; University of Michigan; Ann Arbor MI USA
| | - Shani E. Ross
- Department of Biomedical Engineering; University of Michigan; Ann Arbor MI USA
- Biointerfaces Institute; University of Michigan; Ann Arbor MI USA
- Bioengineering Department; George Mason University; Fairfax VA USA
| | - Mitchell B. Berger
- Department of Obstetrics & Gynecology; University of Michigan; Ann Arbor MI USA
| | - Tim M. Bruns
- Department of Biomedical Engineering; University of Michigan; Ann Arbor MI USA
- Biointerfaces Institute; University of Michigan; Ann Arbor MI USA
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Apostolidis A, Rantell A, Anding R, Kirschner-Hermanns R, Cardozo L. How does lower urinary tract dysfunction (LUTD) affect sexual function in men and women? ICI-RS 2015-Part 2. Neurourol Urodyn 2017; 36:869-875. [DOI: 10.1002/nau.23088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/20/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Angie Rantell
- Department of Urogynaecology; King's College Hospital; London UK
| | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | | | - Linda Cardozo
- Department of Urogynaecology; King's College Hospital; London UK
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9
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Neuromodulation for Pelvic Pain and Sexual Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Marson L, Giamberardino MA, Costantini R, Czakanski P, Wesselmann U. Animal Models for the Study of Female Sexual Dysfunction. Sex Med Rev 2015; 1:108-122. [PMID: 27784584 DOI: 10.1002/smrj.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Significant progress has been made in elucidating the physiological and pharmacological mechanisms of female sexual function through preclinical animal research. The continued development of animal models is vital for the understanding and treatment of the many diverse disorders that occur in women. AIM To provide an updated review of the experimental models evaluating female sexual function that may be useful for clinical translation. METHODS Review of English written, peer-reviewed literature, primarily from 2000 to 2012, that described studies on female sexual behavior related to motivation, arousal, physiological monitoring of genital function and urogenital pain. MAIN OUTCOMES MEASURES Analysis of supporting evidence for the suitability of the animal model to provide measurable indices related to desire, arousal, reward, orgasm, and pelvic pain. RESULTS The development of female animal models has provided important insights in the peripheral and central processes regulating sexual function. Behavioral models of sexual desire, motivation, and reward are well developed. Central arousal and orgasmic responses are less well understood, compared with the physiological changes associated with genital arousal. Models of nociception are useful for replicating symptoms and identifying the neurobiological pathways involved. While in some cases translation to women correlates with the findings in animals, the requirement of circulating hormones for sexual receptivity in rodents and the multifactorial nature of women's sexual function requires better designed studies and careful analysis. The current models have studied sexual dysfunction or pelvic pain in isolation; combining these aspects would help to elucidate interactions of the pathophysiology of pain and sexual dysfunction. CONCLUSIONS Basic research in animals has been vital for understanding the anatomy, neurobiology, and physiological mechanisms underlying sexual function and urogenital pain. These models are important for understanding the etiology of female sexual function and for future development of pharmacological treatments for sexual dysfunctions with or without pain. Marson L, Giamberardino MA, Costantini R, Czakanski P, and Wesselmann U. Animal models for the study of female sexual dysfunction. Sex Med Rev 2013;1:108-122.
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Affiliation(s)
- Lesley Marson
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | | | - Peter Czakanski
- University of Alabama at Birmingham-Departments of Anesthesiology and Obstetrics & Gynecology, Birmingham, AL, USA
| | - Ursula Wesselmann
- University of Alabama at Birmingham-Departments of Anesthesiology and Neurology, Birmingham, AL, USA
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Chu CM, Arya LA, Andy UU. Impact of urinary incontinence on female sexual health in women during midlife. Womens Midlife Health 2015; 1:6. [PMID: 30766693 PMCID: PMC6214215 DOI: 10.1186/s40695-015-0007-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/07/2015] [Indexed: 11/10/2022] Open
Abstract
Sexual health is important to the self worth, emotional well being, and overall quality of life of women in midlife. However, urinary incontinence, which is prevalent in this population, has a negative impact on sexual function. The purpose of this article is to review the impact of urinary incontinence on female sexual dysfunction and discuss the impact of urinary incontinence treatment on sexual function. We carried out a literature review on the effect of stress urinary incontinence and urgency urinary incontinence on sexual health and physiological response, including coital incontinence, satisfaction, desire, orgasm, frequency, and partner relationships. We examined the literature regarding changes in sexual function related to non-surgical and surgical interventions for incontinence. Overall, though studies are lacking and of poor quality, treatment of incontinence has been shown to improve sexual function. Both pelvic muscle training and midurethral slings have been shown to improve sexual function in those with stress urinary incontinence. In urgency urinary incontinence, evidence indicates improvement in sexual function after treatment with anti-muscarinic medications. Coital incontinence commonly improves with treatment of the underlying incontinence subtype. Although problems related to sexual health are complex and involve both psychological and physical factors, it is important to consider treatment of urinary incontinence as part of management of sexual dysfunction.
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Affiliation(s)
- Christine M Chu
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, 3400 Spruce St., 1000 Courtyard Building, Philadelphia, PA 19104 USA
| | - Lily A Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, 3400 Spruce St., 1000 Courtyard Building, Philadelphia, PA 19104 USA
| | - Uduak U Andy
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, 3400 Spruce St., 1000 Courtyard Building, Philadelphia, PA 19104 USA
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Sacral neuromodulation and female sexuality. Int Urogynecol J 2015; 26:1751-7. [PMID: 25876714 DOI: 10.1007/s00192-015-2708-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS An up-to-date review of the impact of a permanent sacral neuromodulation (SNM) implant (Medtronic, Minneapolis, Minnesota, USA) on female sexual function (FSF). METHODS Clinical studies published from January 2001 to February 2014 evaluating the impact and/or safety of permanent SNM on FSF were reviewed. RESULTS Nine studies were selected that investigated the impact on sexual response when the aim of the SNM was to resolve urinary symptoms mainly due to overactive bladder (seven studies) or faecal incontinence. Most women included were of menopausal age. Three studies included sexually inactive women. Post-SNM follow-up varied from 3 to 36 months. Meta-analysis of efficacy results was not possible primarily due to the heterogeneity of the sexual and pelvic dysfunctions. The most specific questionnaire assessing FSF was the Female Sexual Function Index (FSFI) used in six studies. During follow-up all women showed statistically significant improvement (p < 0.05) in at least one FSFI domain compared to baseline. In one study statistically significant improvement (p < 0.05) in the FSFI pain domain was exclusively detected in women with neurological disease. Two studies, however, using the questionnaire to screen for sexual dysfunction did not find any statistically significant differences after SNM. The most severe problems associated with FSF concern loss of libido and reduction in vaginal lubrication which were resolved in one woman following removal of the SNM implant. CONCLUSIONS Actual data are still insufficient to definitely assert the positive effect of SNM on FSF.
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Banakhar M, Gazwani Y, Kelini ME, Al-Shaiji T, Hassouna M. Effect of sacral neuromodulation on female sexual function and quality of life: Are they correlated? Can Urol Assoc J 2014; 8:E762-7. [PMID: 25485001 DOI: 10.5489/cuaj.2300] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTON Sacral neuromodulation (SNM) has become an established therapy for voiding dysfunction. Additional benefits, such as improved bowel functions and bladder pain, have been reported. Improvement in female sexual function after SNM treatment has been suggested; however, reports examining the effects of SNM on female sexual functions are scarce. We evaluate the effects of SNM on female sexual function and its impact on quality of life and analyze any correlation. METHODS Data were collected from January 2010 to May 2012 for all female patients who underwent SNM InterStim (Medtronic, Minneapolis, MN) therapy at a single centre in Canada. They were treated for voiding dysfunction, including refractory over-active bladder, frequency-urgency syndrome and non-obstructive urinary retention. Patients were screened by percutaneous nerve evaluation (PNE) to assess their response to therapy using a 4-day voiding diary. Patients who experienced 50% or more improvement in their voiding parameters were permanently implanted. All patients completed the Female Sexual Function Index (FSFI), Short-Form Health Survey (SF-36), and incontinence questionnaires (Urinary Distress Inventory [UDI]-6) preoperatively and 4 months postoperatively. RESULTS A total of 33 female patients had SNM therapy; 10 were excluded from the study because they were not sexually active. The indications were: refractory overactive bladder in 19, frequency-urgency syndrome in 2, and non-obstructive urinary retention in another 2 patients. SNM therapy significantly improved the total FSFI score (p = 0.011); the components of desire and orgasm showed significant improvement (p = 0.014 and p = 0.035, respectively). Age, body mass index, diagnosis, and urinary symptoms did not show significant correlation with FSFI score improvement. Quality of life showed significant improvement after SNM treatment in 5 categories. There was no correlation between improvement in quality of life and FSFI. CONCLUSION SNM may improve female sexual function and quality of life, yet there is no correlation between the improvement in FSFI and quality of life.
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Affiliation(s)
- Mai Banakhar
- Department of Urology, King Abdulaziz University, Faculty of Medicine, Jeddah, Kingdom of Saudi Arabia
| | - Yahya Gazwani
- Department of Urology, King Abdulaziz University, Faculty of Medicine, Jeddah, Kingdom of Saudi Arabia
| | - Mohamed El Kelini
- Department of Urology, King Abdulaziz University, Faculty of Medicine, Jeddah, Kingdom of Saudi Arabia
| | - Tariq Al-Shaiji
- Department of Urology, University of Toronto, Toronto Western Hospital, Toronto, ON
| | - Magdy Hassouna
- Department of Urology, University of Toronto, Toronto Western Hospital, Toronto, ON
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Percutaneous tibial nerve stimulation as an off-label treatment of clitoral pain. Female Pelvic Med Reconstr Surg 2014; 20:e1-4. [PMID: 25185622 DOI: 10.1097/spv.0000000000000086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Percutaneous tibial nerve stimulation (PTNS) is used to treat refractory urinary frequency, urgency, and urgency urinary incontinence. To date, it is not approved by the US Food and Drug Administration in the treatment of chronic pain syndromes, and its use in the treatment of chronic clitoral pain has not been reported. METHODS We describe 2 cases of women who presented with symptoms of urgency urinary incontinence, urinary frequency, and clitoral pain. After inadequate response to conservative treatment of their urinary symptoms, they received PTNS. RESULTS By the 12th session, significant improvement in urinary symptoms and resolution of clitoral pain were noted. CONCLUSIONS The findings of this report suggest that PTNS may be a therapeutic option in patients with idiopathic clitoral pain.
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Suskind AM, Dunn RL, Kaufman SR, DeLancey JOL, Clemens JQ, Stoffel JT, Hollenbeck BK. Understanding the dissemination of sacral neuromodulation. Surg Innov 2013; 20:625-30. [PMID: 23592732 DOI: 10.1177/1553350613485303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess trends in the use of sacral neuromodulation and to measure the magnitude of variation in its use across geographic regions. METHODS We used the State Ambulatory Surgery Database (SASD) from 2002 to 2009 from Florida to identify patients implanted with a neuromodulator. Age- and gender-adjusted rates of implantation were calculated by year and by geographic region, defined by the Hospital Service Area. The coefficient of variation was estimated to quantify the magnitude of variation for different time periods. RESULTS Adjusted rates of sacral neuromodulation increased significantly from 1.1 per 100,000 population in 2002 to 10.4 per 100,000 population in 2009. The majority of cases were performed for overactive bladder. There was a very large amount of geographic variation in rates of these procedures as evidenced by the high coefficients of variation: 1.67 (2002 and 2003), 1.70 (2004 and 2005), 1.49 (2006 and 2007), and 1.05 (2008 and 2009). CONCLUSIONS Rates of sacral neuromodulation have increased dramatically over the past decade. However, these rates of utilization are highly variable across regions, with some regions performing large numbers of these procedures and other regions performing few to no procedures. This range in practice patterns may reflect medical uncertainty surrounding the role of this procedure.
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Yih JM, Killinger KA, Boura JA, Peters KM. Changes in sexual functioning in women after neuromodulation for voiding dysfunction. J Sex Med 2013; 10:2477-83. [PMID: 23445354 DOI: 10.1111/jsm.12085] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Sacral neuromodulation is a well-established treatment for urinary and bowel disorders with potential use for other disorders such as sexual dysfunction. AIM To evaluate changes in sexual functioning in women undergoing neuromodulation for voiding symptoms. METHODS Patients enrolled in our prospective, observational neuromodulation database study were evaluated. Data were collected from medical records, and patient-completed Female Sexual Function Index (FSFI) and Interstitial Cystitis Symptom-Problem Indices (ICSI-PI) at baseline, 3, 6, and 12 months post-implant. Patients rated overall change in sexual functioning on scaled global response assessments (GRA) at 3, 6, and 12 months post-implant. We grouped women by baseline FSFI scores: less (score<26) and more sexually functional (score≥26). Data were analyzed with Pearson's Chi-square or Fisher's Exact test and repeated measures. MAIN OUTCOMES MEASURES Changes in FSFI and ICSI-PI scores in women grouped by baseline FSFI score<26 and ≥26. RESULTS Of 167 women evaluated, FSFI scores improved overall from preimplant (mean 13.5±8.5) to 12 months (N=72; mean 15.9±8.9, P=0.004). At baseline and each follow-up point, ICSI-PI scores were similar between groups and improved through time. For patients in the FSFI<26 group there was improvement from baseline to 12-month scores (N=63; 11.9±6.9 to 14.8±8.7; P=0.0006). Improved FSFI domains included desire, orgasm, satisfaction, and pain. Furthermore, of the 74 subjects in this group not sexually active at baseline, 10 became sexually active during follow-up. In the FSFI≥26 group there was slight but statistically significant decline in mean scores between baseline and 12 months (N=9; 27.4±1.1 to 24.5±3.4; P=0.0302); however one had become sexually inactive. A significant decrease was seen in the satisfaction domain. CONCLUSIONS Many factors affect sexual functioning in women; however sexual function may improve along with urinary symptoms after neuromodulation.
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Affiliation(s)
- Jessica M Yih
- Department of Urology, Beaumont Health System, Royal Oak, MI, USA
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Abstract
OBJECTIVE Stimulation of the pudendal nerve or the anal sphincter could provide therapeutic options for fecal incontinence with little involvement of other organs. The goal of this project was to assess the effects of pudendal nerve and anal sphincter stimulation on bladder and anal pressures. DESIGN Ten virgin female Sprague Dawley rats were randomly allocated to control (n = 2), perianal stimulation (n = 4), and pudendal nerve stimulation (n = 4) groups. A monopolar electrode was hooked to the pudendal nerve or placed on the anal sphincter. Aballoon catheter was inserted into the anus to measure anal pressure, and a catheter was inserted into the bladder via the urethra to measure bladder pressure. Bladder and anal pressures were measured with different electrical stimulation parameters and different timing of electrical stimulation relative to spontaneous anal sphincter contractions. RESULTS Increasing stimulation current had the most dramatic effect on both anal and bladder pressures. An immediate increase in anal pressure was observed when stimulating either the anal sphincter or the pudendal nerve at stimulation values of 1 mA or 2 mA. No increase in anal pressure was observed for lower current values. Bladder pressure increased at high current during anal sphincter stimulation, but not as much as during pudendal nerve stimulation. Increased bladder pressure during anal sphincter stimulation was due to contraction of the abdominal muscles. CONCLUSION Electrical stimulation caused an increase in anal pressures with bladder involvement only at high current. These initial results suggest that electrical stimulation can increase anal sphincter pressure, enhancing continence control.
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Proietti S, Giannantoni A, Sahai A, Khan MS, Dasgupta P. Overactive bladder and sexual function: a nightmare couple. BJU Int 2012; 110:921-4. [DOI: 10.1111/j.1464-410x.2012.11411.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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