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Reading Room


Activity Faculty

Charles R. Rardin, MD
Alpert Medical School of Brown University
Providence, Rhode Island


Article Summary

Gill BS, Swartz MA, Firoozi F, et al. Improved sexual and urinary function in women with sacral nerve stimulation. Neuromodulation. 2011;14:436-443.


Introduction

Correlation between different forms of pelvic floor dysfunction, including urinary incontinence, pelvic organ prolapse, and female sexual dysfunction, have been observed to varying degrees in a variety of studies. The interrelationships between pelvic floor diagnoses and female sexual dysfunction are generally considered to be dependent; that is, improvements seen in sexual function after treatment for incontinence are thought to be dependent on successful treatment of the incontinence. This article seeks to determine whether there might be independent benefits on sexual function as a result of stimulation of relevant neural pathways as well as the direct effects on incontinence


Methods

Results

 

Baseline

3-Month Follow-up

P-value

UDI-6 total

54.2

29.2

0.008

IIQ-7 total

81.0

11.9

0.008

FSFI arousal

3.8

4.5

0.047

FSFI satisfaction

3.6

4.6

0.031

FSFI total

22.6

25.8

0.023



Expert Opinion

This is one of several studies investigating the relationship between improvements in urinary and sexual function in women undergoing SNS (see references and links below).  There are several significant weaknesses of this study, including the small sample size, failure to reach the intended sample size, limited follow-up, and the use of a non-validated female sexual health questionnaire. However, it does provide some additional insight into the possibility that the intervention may stimulate neural pathways relevant to sexual function and urinary function dependently and independently, and may serve as a building block for further research in the area.


Article Link

http://www.ncbi.nlm.nih.gov/pubmed/21854492


Additional reading on this topic:
  1. Pauls RN, Marinlovic SP, Silva WA, Rooney CM, Kleeman SD, Karram MM. Effects of sacral neuromodulation on female sexual function. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:391-395. http://www.ncbi.nlm.nih.gov/pubmed/16868656
  2. Lombardi G, Mondaini N, Macchiarella A, Cilotti A, Del Popolo G. Clinical female sexual outcome after sacral neuromodulation implant for lower urinary tract symptom (LUTS). J Sex Med. 2008;5:1411-1417. http://www.ncbi.nlm.nih.gov/pubmed/18373528
  3. Zabihi N, Mourtzinos A, Maher MG, Raz S, Rodriguez LV. The effects of bilateral caudal epidural S2-4 neuromodulation on female sexual function. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:697-700. http://www.ncbi.nlm.nih.gov/pubmed/18060341
  4. Ingber MS, Ibrahim IA, Killinger KA, Diokno AC, Peters KM. Neuromodulation and female sexual function: does treatment for refractory voiding symptoms have an added benefit? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1055-1059. http://www.ncbi.nlm.nih.gov/pubmed/19440647