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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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Sobti A, Shawer S, Ballard P, Khunda A. Bladder pain syndrome and sexual function: a systematic review and meta-analysis. Int Urogynecol J 2023; 34:2359-2371. [PMID: 37608090 DOI: 10.1007/s00192-023-05633-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/17/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder pain syndrome (BPS)/interstitial cystitis can adversely affect physical, mental, and sexual health. The aim of the systematic review is to compare sexual function between patients with BPS and healthy controls and to examine whether or not treatment of BPS improves sexual function. METHODS A literature search was conducted on Embase, Medline, and other databases. Studies comparing sexual function in BPS patients with healthy controls and before/after treatment were included. Where appropriate, data were pooled in a meta-analysis, using a random effects model and the standardised mean difference (SMD) was used for comparison. RESULTS Out of 384 studies initially identified, 26 studies met the inclusion criteria for the systematic review and 11 for the meta-analysis. Six studies compared sexual function in BPS cases with healthy controls. All studies found that the Female Sexual Function Index (FSFI) was worse in BPS cases than in controls. Pooled data from 5 studies showed that the SMD was -1.02 (CI -1.64, -0.4) in total FSFI scores between the cases and controls, p=0.001. Further analysis showed better sexual function in all FSFI subdomains in healthy controls. Five studies compared sexual function in BPS patients before treatment with after treatment. Pooled data from 3 studies showed an overall improvement in total FSFI score after intravesical treatment: SMD=0.69 (CI 0.23, 1.14), p=0.003. Further analysis showed improvement in all subdomains. CONCLUSION Our review suggests that sexual function might be worse in BPS patients than in the general population, but it seems to improve with intravesical BPS treatment.
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Affiliation(s)
- A Sobti
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
| | - S Shawer
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - P Ballard
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - A Khunda
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
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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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Balzarro M, Rubilotta E, Braga A, Bassi S, Processali T, Artibani W, Serati M. OnabotulinumtoxinA detrusor injection improves female sexual function in women with overactive bladder wet syndrome. Eur J Obstet Gynecol Reprod Biol 2018; 225:228-231. [PMID: 29753213 DOI: 10.1016/j.ejogrb.2018.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/11/2018] [Accepted: 05/02/2018] [Indexed: 01/23/2023]
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Neuromodulation for the Treatment of Endometriosis-Related Symptoms. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sacral and pudendal neuromodulation have been advocated for the treatment of refractory pelvic pain, urinary urgency and retention, as well as fecal incontinence or constipation, all of which are commonly related to endometriosis and/or its surgical treatment. In this review, the mechanisms of action and different routes of neuromodulation will be detailed, as well as all the studied applications of neuromodulation on ameliorating symptoms related to endometriosis and/or its treatment.
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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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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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Parnell BA, Howard JF, Geller EJ. The effect of sacral neuromodulation on pudendal nerve function and female sexual function. Neurourol Urodyn 2014; 34:456-60. [PMID: 24615871 DOI: 10.1002/nau.22579] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/03/2014] [Indexed: 01/23/2023]
Abstract
AIMS To quantify changes in pudendal nerve function with sacral neuromodulation (SNM). To understand the relationship of pudendal nerve function to SNM treatment response for overactive bladder. To assess the relationship between female sexual function and pudendal nerve function after SNM. METHODS Women undergoing SNM between January 2010 and May 2011 were enrolled. Baseline pudendal nerve terminal motor latencies (PNTML) were measured bilaterally. Subjects underwent peripheral nerve evaluation (PNE) prior to SNM therapy. PNTML was measured at 1 and 6 weeks after sacral neuromodulator implant. Women who did not undergo permanent implantation were reassessed at the end of the 1-week PNE testing phase. Pelvic floor and sexual function questionnaires were administered at baseline and follow-up to assess pelvic floor and sexual function. RESULTS Of 34 women enrolled, 31 were evaluated. Mean age was 67.4 ± 14.2 years with 29/34 (85.3%) treated for refractory overactive bladder. Thirty of 31 (96.7%) went on to a permanent implant. PNE success rate was 73.5% (25/33). Mean PNTML changed from 2.74 ± 0.52 msec at baseline to 2.57 ± 0.50 msec at 6 weeks postop (P = 0.198). Baseline amplitude remained stable at 1 and 6 weeks. At 6 weeks PISQ-12 scores showed improved sexual function (P = 0.034) and PFDI-20 and PFIQ-7 scores showed improved pelvic floor, colorectal and urinary symptoms (P < 0.05). CONCLUSIONS Women with refractory overactive bladder and non-obstructive urinary retention have abnormal pudendal nerve function, which showed a non-significant trend toward improvement after SNM. Sexually active women undergoing sacral neuromodulation experienced improvement in sexual function. Quality of life improved due to improvement in urinary and colorectal function.
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Affiliation(s)
- Brent A Parnell
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - James F Howard
- Department of Neurology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth J Geller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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van Voskuilen AC, Oerlemans DJ, Gielen N, Lansen-Koch SMP, Weil EHJ, van Lankveld JJDM, van den Hombergh U, Baeten CGMI, van Kerrenbroeck PEV. Sexual response in patients treated with sacral neuromodulation for lower urinary tract symptoms or fecal incontinence. Urol Int 2012; 88:423-30. [PMID: 22538447 DOI: 10.1159/000336911] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 01/29/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine whether sacral neuromodulation (SNM) for urinary symptoms or fecal incontinence gives improvement of female sexual function and whether improvement is due to physiological or psychological factors. METHODS Between 2002 and 2008, 8 patients had an array of questionnaires before and after SNM implantation. The questionnaires were: the Questionnaire for Screening for Sexual Dysfunctions, the Golombok Rust Inventory of Sexual Satisfaction, the Symptom Checklist-90, the Maudsley Marital Questionnaire and the McGill-Mah Orgasm Questionnaire. Three of these 8 patients underwent vaginal plethysmography before and after implantation. RESULTS No statistically significant changes were found, although there seems to be a trend toward improvement in orgasm scores. In plethysmography all 3 patients showed increased vaginal pulse amplitude with the stimulator turned on with both erotic and non-erotic stimuli. CONCLUSIONS This study does not show a clear effect of SNM on sexual function, although there seems to be an improvement in orgasm scores. The lack of response on psychological questionnaires and the increase in vaginal pulse amplitude after SNM implantation indicate that there might be a physiological response.
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Affiliation(s)
- A C van Voskuilen
- Department of Urology, University Hospital of Maastricht, Maastricht, The Netherlands.
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Gill BC, Swartz MA, Firoozi F, Rackley RR, Moore CK, Goldman HB, Vasavada SP. Improved sexual and urinary function in women with sacral nerve stimulation. Neuromodulation 2011; 14:436-43; discussion 443. [PMID: 21854492 DOI: 10.1111/j.1525-1403.2011.00380.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Urinary and sexual function improve following sacral nerve stimulation (SNS) for refractory overactive bladder. No significant associations between these changes have been found. Whether improvements in sexual function are independent of or secondary to improvements in urinary function remains unclear. The aim of this study was to analyze changes in urinary and sexual function in a homogeneous sample of patients undergoing SNS for urge urinary incontinence and subsequently identify associations between the two. MATERIALS AND METHODS A prospective database was created. Enrollees underwent a full history and physical examination at the first office visit. Multiple-day voiding diaries with validated and investigator-designed questionnaires were administered at baseline and follow-up as standard implantation procedures and to assess changes in urinary and sexual function, respectively. Analyses were completed using data from patients who were sexually active at baseline and follow-up. RESULTS Statistically significant improvements in urinary and sexual function occurred according to multiple metrics. Patient global impression scales categorized all patients' urinary conditions as improved, with most being less severe. Validated urinary symptom and quality of life scores improved significantly. After treatment, most patients were incontinent less often with sexual activity and felt less restricted from sexual activity by fear of incontinence. Validated quantification of sexual function demonstrated significant improvements in overall sexual function, arousal, and satisfaction. No significant associations between changes in urinary and sexual function were noted; however, trends appeared to exist between the two. CONCLUSIONS Improved sexual function was not significantly associated with improved urinary function after SNS despite apparent trends between the two. Larger samples are required to definitively demonstrate this conclusion.
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Affiliation(s)
- Bradley C Gill
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Signorello D, Seitz CC, Berner L, Trenti E, Martini T, Galantini A, Lusuardi L, Lodde M, Pycha A. Impact of Sacral Neuromodulation on Female Sexual Function and His Correlation with Clinical Outcome and Quality of Life Indexes: A Monocentric Experience. J Sex Med 2011; 8:1147-55. [DOI: 10.1111/j.1743-6109.2010.02189.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sako T, Inoue M, Watanabe T, Ishii A, Yokoyama T, Kumon H. Impact of overactive bladder and lower urinary tract symptoms on sexual health in Japanese women. Int Urogynecol J 2010; 22:165-9. [PMID: 20798921 DOI: 10.1007/s00192-010-1250-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 08/04/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study aims to assess whether lower urinary tract symptoms (LUTS) affect sexual function in Japanese females. METHODS A multi-component questionnaire was mailed to 576 female hospital workers. It contained the Female Sexual Function Index (FSFI) and a self-administered questionnaire pertaining to LUTS. RESULTS Of the 276 responses (overall response rate, 47.9%), 146 questionnaires were evaluable. LUTS had been experienced by 72 (49.3%) of the respondents, 17 (11.6%) had urge urinary incontinence, and 35 (24.0%) had stress urinary incontinence (SUI). The mean overall FSFI score was 22.4 ± 9.0. The mean FSFI score was not significantly different between women with LUTS and women without LUTS (23.2 ± 9.3 and 21.6 ± 8.8, respectively; P = 0.057). However, the mean FSFI score of women with SUI was significantly lower than that of women without it (P = 0.04). No other symptoms showed significant differences in FSFI scores. CONCLUSIONS Our results suggest that sexual dysfunction is related to SUI.
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Affiliation(s)
- Tomoko Sako
- Department of Urology, Okayama University Hospital, 2-5-1 Shikatacho, Okayama, 700-8558, Japan
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