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Sacral neuromodulation and female sexuality

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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.

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Conflict of interest

Dr. Giuseppe Lombardi: None

Prof. Enrico Finazzi Agrò: consultant Allergan, Pfizer, Astellas, Sigma Tau, Mylan; speaker honorarium GlaxoSmithKline, Ibsa, Coloplast, Lilly; trial participation Astellas

Dr. Giulio Del Popolo: consultant Hollister, Ipsen, Allergan, Wellspect, Apogepha; speaker Astellas, Allergan, Sigma Tau; trial participation Pfizer, Allergan, Ipsen, Recordati, Astellas

Authors’ contributions

G. Lombardi: protocol, project development, data collection and management of data analysis, manuscript writing/editing

E. Finazzi Agrò: project development, manuscript writing

G. Del Popolo: data collection, protocol, project development

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Authors and Affiliations

  1. Neuro-Urology Department, Careggi University Hospital, Largo Palagi 1, 50127, Florence, Italy

    Giuseppe Lombardi & Giulio Del Popolo

  2. Experimental Medicine and Surgery Depatment, Tor Vergata University, Rome, Italy

    Enrico Finazzi Agrò

Authors
  1. Giuseppe Lombardi
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  2. Enrico Finazzi Agrò
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  3. Giulio Del Popolo
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Corresponding author

Correspondence to Giuseppe Lombardi.

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Lombardi, G., Finazzi Agrò, E. & Del Popolo, G. Sacral neuromodulation and female sexuality. Int Urogynecol J 26, 1751–1757 (2015). https://doi.org/10.1007/s00192-015-2708-7

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  • DOI: https://doi.org/10.1007/s00192-015-2708-7

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