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The effect of percutaneous tibial nerve stimulation on sexual function: A systematic review and meta-analysis
IUGA Academy. Kershaw V. Jun 30, 2018; 212950
Topic: Sexual Dysfunction
Dr. Victoria Kershaw
Dr. Victoria Kershaw

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The effect of percutaneous tibial nerve stimulation on sexual function: A systematic review and meta-analysis

Kershaw, V1; Khunda, A1; Ballard, P1

1: South Tees Hospitals

Introduction: Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive form of neuromodulation used to treat overactive bladder (OAB), faecal incontinence (FI), voiding dysfunction and pelvic pain1,2. Female sexual dysfunction is highly prevalent among this patient group with up to 50% of women affected3. It is plausible that PTNS may improve sexual dysfunction simply by improving urinary and bowel symptoms, which in turn leads to an improvement in sexual life, or by direct stimulation of S3 and the nervous innervation of pelvic organs.

Objective: We aim to examine the effect of PTNS on sexual function in patients undergoing treatment for pelvic floor dysfunction by systematically reviewing the literature and pooling the data in a meta-analysis.

Methods:The literature search was conducted using theEmbase and Cochranedatabases. We selected prospective studies involving adult females undergoing PTNS for pelvic floor dysfunction, which reported sexual function outcomes using a validated tool, either before and after treatment, or comparing treatment outcomes to a control group. Initial results yielded 73 citations. From these, 15 articles met our inclusion criteria.Five articles were doubly reported, leaving 7 studies in the systematic review. Only four studies reported enough information to be included in our meta-analysis.

Results:Two studies were randomised controlled trials and five were before-after studies. Three studies reported on patients suffering from overactive bladder, one reported on patients suffering from faecal incontinence, one on patients suffering from pelvic pain and two reported on mixed patients. The commonest tool used was the Female Sexual Function Index, which was used in three studies. The number of participants in each studyranged from 24 to 220. Threeout of seven studies reported a positive effect of PTNS on sexual function.In the meta-analysis of four studies there was a significant improvement in general sexual function with PTNS (SMD=0.34, 95% CI -0.67, 0.01. P= 0.04. I2 =14%). When the two studies using the ePAQ-PF (electronic Personal Assessment Questionnaire – Pelvic Floor) tool were pooled in a subgroup analysis, there was a significant improvement in the domain measuring the effect of bowel symptoms on sexual function with PTNS (MD=17.6, 95% CI 2.23, 32.97. P=0.02. I2=0%).

Conclusion:We report the first systematic review on the effect of PTNS on sexual function. Although the studies are of small size and low quality, the results are promising in terms of a positive effect of PTNS on sexual function, in the context of patients undergoing treatment for pelvic floor dysfunction.

References:

  1. Burton C, Sajja A, Latthe P.M. (November 2012). “Effectiveness of percutaneous posterior tibial nerve stimulation for OAB: a systematic review and meta-analysis”. Neurology and Urodynamics. 31 (8): 1206-16.
  2. National Institute for Clinical Excellence. “Urinary Incontinence in women: management”. Guidance issue date September 2013, Updated November 2015. http://guidance.nice.org.uk/CG171
  3. Coyne KS, Margolis MK, Jumadilova Z, Bavendam T, Mueller E, Rogers R. (May 2007). “Overactive bladder and women’s sexual health: what is the impact?”. Journal of sexual medicine. 4 (3): 656-66.

Disclosure:

Work supported by industry: no.

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