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International Urogynecology Journal

Published in:

01-12-2015 | Review Article

Sacral neuromodulation and female sexuality

Authors: Giuseppe Lombardi, Enrico Finazzi Agrò, Giulio Del Popolo

Published in: International Urogynecology Journal | Issue 12/2015

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.

Siddiqui NY, Wu JM, Amundsen CL (2010) Efficacy and adverse events of sacral nerve stimulation for overactive bladder: a systematic review. Neurourol Urodyn 29:S18–S23. doi:10.1002/ nau.20786 CrossRefPubMed

Kessler TM, La Framboise D, Trelle S et al (2010) Sacral neuromodulation for neurogenic lower urinary tract dysfunction: systematic review and metaanalysis. Eur Urol 58:865–874. doi:10.1016/j.eururo.2010.09.024 CrossRefPubMed

Comiter CV (2008) Sacral nerve stimulation to treat nonobstructive urinary retention in women. Curr Urol Rep 9:405–411CrossRefPubMed

Jarrett ME, Mowatt G, Glazener CM et al (2004) Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 91:1559–1569CrossRefPubMed

Kamm MA, Dudding TC, Melenhorst J et al (2010) Sacral nerve stimulation for intractable constipation. Gut 59:333–340. doi:10.1136/gut.2009.187989 CrossRefPubMed

Peters KM (2012) Sacral neuromodulation is an effective treatment for interstitial cystitis/bladder pain syndrome: pro. J Urol 188(6):2043–2054. doi:10.1016/j.juro.2012.09.072 CrossRefPubMed

Whitmore K, Siegel JF, Kellogg-Spadt S (2007) Interstitial cystitis/painful bladder syndrome as a cause of sexual pain in women: a diagnosis to consider. J Sex Med 4:720–727CrossRefPubMed

Siegel S, Paszkiewicz E, Kirkpatrick C, Hinkel B, Oleson K (2001) Sacral nerve stimulation in patients with chronic intractable pelvic pain. J Urol 166:1742–1745CrossRefPubMed

Handa VL, Cundiff G, Chang HH, Helzlsouer KJ (2008) Female sexual function and pelvic floor disorders. Obstet Gynecol 111:1045–1052. doi:10.1097/AOG.0b013e31816bbe85 PubMedCentralCrossRefPubMed

10.

Norton P, Brubaker L (2006) Urinary incontinence in women. Lancet 367:57–67CrossRefPubMed

11.

Salonia A, Zanni G, Nappi RE, Briganti A, Deho F, Fabbri F, Colombo R, Guazzoni G, Di Girolamo V, Rigatti P, Montorsi F (2004) Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: results of a cross sectional study. Eur Urol 45:642–648CrossRefPubMed

12.

Leroi AM (2011) The role of sacral neuromodulatin in double incontinence. Colorectal Dis 13:15–18. doi:10.1111/j.1463-1318.2010.02520.x CrossRefPubMed

13.

El-Gazzaz G, Zutshi M, Salcedo L et al (2009) Sacral neuromodulation for the treatment of fecal incontinence and urinary incontinence in female patients: long-term follow-up. Int J Colorectal Dis 24:1377–1381. doi:10.1007/s00384-009-0745-8 CrossRefPubMed

14.

Pettit PD, Thompson JR, Chen AH (2002) Sacral neuromodulation: new applications in the treatment of female pelvic floor dysfunction. Curr Opin Obstet Gynecol 14(5):521–525CrossRefPubMed

15.

Bernstein AJ, Peters KM (2005) Expanding indications for neuromodulation. Urol Clin N Am 32(1):59–63CrossRef

16.

Pauls RN, Marinkovic SP, Silva WA, Rooney CM, Kleeman SD, Karram MM (2007) Effects of sacral neuromodulation on female sexual function. Int Urogynecol J Pelvic Floor Dysfunct 18(4):391–395CrossRefPubMed

17.

Lombardi G, Mondaini N, Macchiarella A, Cilotti A, Del Popolo G (2008) Clinical female sexual outcome after sacral neuromodulation implant for lower urinary tract symptom (LUTS). J Sex Med 5(6):1411–1417. doi:10.1111/j.1743-6109.2008.00812.x CrossRefPubMed

18.

Zabihi N, Mourtzinos A, Maher MG, Raz S, Rodríguez LV (2008) The effects of bilateral caudal epidural S2-4 neuromodulation on female sexual function. Int Urogynecol J Pelvic Floor Dysfunct 19(5):697–700CrossRefPubMed

19.

Jarrett ME, Nicholls RJ, Kamm MA (2005) Effect of sacral neuromodulation for faecal incontinence on sexual activity. Colorectal Dis 7(5):523–525CrossRefPubMed

20.

van Voskuilen AC, Oerlemans DJ, Gielen N, Lansen-Koch SM, Weil EH, van Lankveld JJ, van den Hombergh U, Baeten CG, van Kerrenbroeck PE (2012) Sexual response in patients treated with sacral neuromodulation for lower urinary tract symptoms or fecal incontinence. Urol Int 88(4):423–430. doi:10.1159/000336911 CrossRefPubMed

21.

Signorello D, Seitz CC, Berner L, Trenti E, Martini T, Galantini A, Lusuardi L, Lodde M, Pycha A (2011) 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 8(4):1147–1155. doi:10.1111/j.1743-6109.2010.02189.x CrossRefPubMed

22.

Spinelli M, Giardiello G, Gerber M et al (2003) New sacral neuromodulation lead for percutaneous implantation using local anesthesia: description and first experience. J Urol 170:1905–1907CrossRefPubMed

23.

McKenna KE (2002) The neurophysiology of female sexual function. World J Urol 20:93–100CrossRefPubMed

24.

Albright TS, Gehrich AP, Wright J, Davis GD (2004) Neurophysiology of the pelvic floor and neurodiagnostic evaluation. J Pelvic Med Surg 10:123–128CrossRef

25.

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol 21:5–26. doi:10.1007/s00192-009-0976-9 CrossRef

26.

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther 89:873–80PubMed

27.

Higgins JPT, Green S (ed.) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2011. Available from www.cochrane-handbook.org

28.

Rosen R, Brown C, Heiman J et al (2000) The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208CrossRefPubMed

29.

Wiegel MJ, Meston C, Rosen R (2005) The female sexual function index (FSFI): cross validation and development of clinical cutoff scores. J Sex Marital Ther 31:1–20CrossRefPubMed

30.

Parnell BA, Howard JF, Geller EJ (2014) The effect of sacral neuromodulation on pudendal nerve function and female sexual function. Neurourol Urodyn. doi:10.1002/nau.22579 PubMed

31.

Gill BC, Swartz MA, Firoozi F, Rackley RR, Moore CK, Goldman HB, Vasavada SP (2011) Improved sexual and urinary function in women with sacral nerve stimulation. Neuromodulation 14(5):436–443. doi:10.1111/j.1525-1403.2011.00380.x CrossRefPubMed

32.

Jadav AM, Wadhawan H, Jones GL, Wheldon LW, Radley SC, Brown SR (2013) Does sacral nerve stimulation improve global pelvic function in women? Colorectal Dis 15(7):848–857. doi:10.1111/codi.12181 CrossRefPubMed

33.

Hohenfellner M, Humke J, Hampel C, Dahms S, Matzel K, Roth S, Thüroff JW, Schultz-Lampel D (2001) Chronic sacral neuromodulation for treatment of neurogenic bladder dysfunction: long-term results with unilateral implants. Urology 58(6):887–892CrossRefPubMed

34.

Rogers RG, Coaters KW, Kammerer-Doak D et al (2003) A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct 14:164–168CrossRefPubMed

35.

Jones GL, Radley SC, Lumb J, Jha S (2008) Electronic pelvic floor symptoms assessment: tests of data quality of ePAQ-PF. Int Urogynecol J Pelvic Floor Dysfunct 19:1337–1347. doi:10.1007/s00192-008-0655-2 CrossRefPubMed

36.

Rust J, Golombok S (1985) The Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Br J Clin Psychol 24:63–64CrossRefPubMed

37.

Mah K, Binik YM (2005) Are orgasms in the mind or the body? Psychosocial versus physiological correlates of orgasmic pleasure and satisfaction. J Sex Marital Ther 31:187–200CrossRefPubMed

38.

O’Leary MP, Sant GR, Fowler FJ Jr, Whitmore KE, Spolarich-Kroll J (1997) The interstitial cystitis symptom index and problem index. Urology 49(5a Suppl):58–63CrossRefPubMed

39.

Sintchak G, Geer JH (1975) A vaginal plethysmography system. Psychophysiology 12:113–115CrossRefPubMed

40.

Connel K, Guess MK, La Combe J et al (2005) Evaluation of the role of pudendal nerve integrity in female sexual function using noninvasive techniques. Am J Obstet Gynecol 192:1712–1717CrossRef

41.

Kingsberg SA, Simon JA, Goldestein I (2008) The current outlook for testosterone in the management of hypoactive sexual desire disorder in post-menopausal women. J Sex Med 2:182–193. doi:10.1111/j.1743-6109.2008.00961.x CrossRef

42.

Nappi RE, Albani F, Vaccaro R, Sardella B, Salonia A, Chiovato L, Spinillo A (2008) Use of the Italian translation of the female sexual function index (FSFI) in routine gynaecological practice. Gynecol Endocrinol 24:214–219. doi:10.1080/09513590801925596 CrossRefPubMed

43.

Ramsay LB, Wright J Jr, Fischer JR (2009) Sacral neuromodulation in the treatment of vulvar vestibulitis syndrome. Obstet Gynecol 114:487–489. doi:10.1097/AOG.0b013e3181af5f80 CrossRefPubMed

44.

Marcelissen T, Van Kerrebroeck P, de Wachter S (2010) Sacral neuromodulation as a treatment for neuropathic clitoral pain after abdominal hysterectomy. Int Urogynecol J 21(10):1305–1307. doi:10.1007/s00192-010-1145-x PubMedCentralCrossRefPubMed

45.

Fariello JY, Whitmore K (2010) Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction. Int Urogynecol J 21:1553–1558. doi:10.1007/s00192-010-1281-3 CrossRefPubMed

46.

Wehbe SA, Whitmore K, Ho MH (2010) Sacral neuromodulations for female lower urinary tract, pelvic floor, and bowel disorders. Curr Opin Obstet Gynecol 22(5):414–419. doi:10.1097/GCO.0b013e32833e49d7 CrossRefPubMed

47.

Cai RS, Alexander MS, Marson L (2008) Activation of somatosensory afferents elicit changes in vaginal blood flow and the urethrogenital reflex via autonomic efferents. J Urol 180:1167–1172. doi:10.1016/j.juro.2008.04.139 CrossRefPubMed

48.

Patel M, O’Sullivan DM, Steinberg AC (2009) Symptoms of anal incontinence and impact on sexual function. J Reprod Med 54(8):493–498PubMed

49.

Dudding TC (2011) Future indications for sacral nerve stimulation. Colorectal Dis 13(Suppl 2):23–28. doi:10.1111/j.1463-1318.2010.02522.x CrossRefPubMed

50.

van Balken MR, Vergunst H, Bemelmans BL (2006) Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation. Int J Impot Res 18(5):470–475CrossRefPubMed

Title: Sacral neuromodulation and female sexuality
Authors: Giuseppe Lombardi
Enrico Finazzi Agrò
Giulio Del Popolo
Publication date: 01-12-2015
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 12/2015
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2708-7

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Sacral neuromodulation and female sexuality

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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