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Sacral neuromodulation and sexual function: a systematic review and meta-analysis of the literature

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Abstract

Introduction and hypothesis

Sexual function is being increasingly recognized as an important patient-reported outcome. Sacral neuromodulation (SNM) is a treatment with an expanding list of indications. The effect of sacral neuromodulation on sexual function has been examined in a number of studies with variable results. In this review, we aim to systematically review the literature and pool the data if appropriate.

Methods

The literature search was conducted primarily on the Healthcare Databases Advanced Search (HDAS) platform using the Medline, EMBASE and CINHAL search engines. Of 196 initial citations, 17 articles met our predefined inclusion criteria. Thirteen studies reported enough information to be included in our meta-analysis. RevMan5 software was used for analysis.

Results

Eight of 17 studies reported a positive effect of SNM on sexual function. Pooled analysis of data from 11 studies involving 573 patients before SNM and 438 patients after SNM showed significant improvement in sexual function (SMD = −0.39; 95% CI: −0.58 to −0.19; p = 0.0001). The results remained significant in most subgroup analyses except in patients suffering from fecal incontinence.

Conclusions

SNM in women with pelvic floor disorders, especially bladder dysfunction, seems to have a positive effect on sexual function. This needs to be verified in adequately powered primary research using sexual function as the primary outcome.

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Acknowledgements

We are grateful to the following authors who upon request supplied further information or anonymized data for the purpose of data synthesis: Mr. Anil Reddy [29], Dr. Rachel Pauls, Dr. Eunsun Yook [17], Dr. Mona Rydningen [40], Dr. Steven Siegel, Dr. Kellie Berg [38], Dr. Bradley Gill [24] and Dr. Gil-Sousa [35].

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  1. James Cook University Hospital, Middlesbrough, TS4 3BW, UK

    Aethele Khunda, Carol McCormick & Paul Ballard

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Correspondence to Aethele Khunda.

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Aethele Khunda received an educational travel grant from Medtronic plc.

Carol McCormick: None to declare.

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International Urogynecology Association 43rd annual meeting, Vienna, Austria, 30/06/2018.

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Khunda, A., McCormick, C. & Ballard, P. Sacral neuromodulation and sexual function: a systematic review and meta-analysis of the literature. Int Urogynecol J 30, 339–352 (2019). https://doi.org/10.1007/s00192-018-3841-x

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