Skip to main content
Erschienen in: International Urogynecology Journal 12/2015

01.12.2015 | Review Article

Sacral neuromodulation and female sexuality

verfasst von: Giuseppe Lombardi, Enrico Finazzi Agrò, Giulio Del Popolo

Erschienen in: International Urogynecology Journal | Ausgabe 12/2015

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
3.
Zurück zum Zitat Comiter CV (2008) Sacral nerve stimulation to treat nonobstructive urinary retention in women. Curr Urol Rep 9:405–411CrossRefPubMed Comiter CV (2008) Sacral nerve stimulation to treat nonobstructive urinary retention in women. Curr Urol Rep 9:405–411CrossRefPubMed
4.
Zurück zum Zitat 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 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
7.
Zurück zum Zitat 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 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
8.
Zurück zum Zitat 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 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
11.
Zurück zum Zitat 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 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
13.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Bernstein AJ, Peters KM (2005) Expanding indications for neuromodulation. Urol Clin N Am 32(1):59–63CrossRef Bernstein AJ, Peters KM (2005) Expanding indications for neuromodulation. Urol Clin N Am 32(1):59–63CrossRef
16.
Zurück zum Zitat 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 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
18.
Zurück zum Zitat 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 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.
Zurück zum Zitat Jarrett ME, Nicholls RJ, Kamm MA (2005) Effect of sacral neuromodulation for faecal incontinence on sexual activity. Colorectal Dis 7(5):523–525CrossRefPubMed Jarrett ME, Nicholls RJ, Kamm MA (2005) Effect of sacral neuromodulation for faecal incontinence on sexual activity. Colorectal Dis 7(5):523–525CrossRefPubMed
20.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
24.
Zurück zum Zitat Albright TS, Gehrich AP, Wright J, Davis GD (2004) Neurophysiology of the pelvic floor and neurodiagnostic evaluation. J Pelvic Med Surg 10:123–128CrossRef 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
32.
33.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
36.
Zurück zum Zitat Rust J, Golombok S (1985) The Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Br J Clin Psychol 24:63–64CrossRefPubMed Rust J, Golombok S (1985) The Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Br J Clin Psychol 24:63–64CrossRefPubMed
37.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
40.
Zurück zum Zitat 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 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
42.
Zurück zum Zitat 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 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/​0951359080192559​6 CrossRefPubMed
48.
Zurück zum Zitat Patel M, O’Sullivan DM, Steinberg AC (2009) Symptoms of anal incontinence and impact on sexual function. J Reprod Med 54(8):493–498PubMed Patel M, O’Sullivan DM, Steinberg AC (2009) Symptoms of anal incontinence and impact on sexual function. J Reprod Med 54(8):493–498PubMed
50.
Zurück zum Zitat 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 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
Metadaten
Titel
Sacral neuromodulation and female sexuality
verfasst von
Giuseppe Lombardi
Enrico Finazzi Agrò
Giulio Del Popolo
Publikationsdatum
01.12.2015
Verlag
Springer London
Erschienen in
International Urogynecology Journal / Ausgabe 12/2015
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-015-2708-7

Weitere Artikel der Ausgabe 12/2015

International Urogynecology Journal 12/2015 Zur Ausgabe

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.