Transcutaneous Electrical Nerve Stimulation to Improve Female Sexual Dysfunction Symptoms: A Pilot Study

Zimmerman, Lauren; Gupta, Priyanka; O'Gara, Florence; Langhals, Nicholas B.; Berger, Mitchell B.; Bruns, Tim M.

doi:10.1111/ner.12846

Cited by 17 publications

(16 citation statements)

References 51 publications

(71 reference statements)

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“…Thus our reduced-contact stimulation technique may have limited the efficacy of the nerve recruitment and contributed to the relatively inconclusive stimulation results in Treatment animals. Additionally, our recent clinical study using skin-surface stimulation had greater improvements in sexual function for tibial nerve stimulation than genital nerve stimulation, in a small sample size [22], suggesting that alternate nerve targets may have stronger effects. Future studies with direct neural stimulation comparing genital or pudendal nerve stimulation to other nerve targets may yield more conclusive results.…”

Section: Plos Onementioning

confidence: 85%

“…Weekly posterior tibial nerve stimulation (PTNS) sessions with a percutaneous needle electrode for similar patients has also shown promise [20], [21]. Recently we showed that 30-minute weekly sessions of skin-surface PTNS or stimulation on either side of the clitoris to target the genital branch of the pudendal nerve in women without bladder problems could improve the genital arousal aspects of FSD [22]. The underlying mechanisms of these improvements are not known.…”

Section: Introductionmentioning

confidence: 99%

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The rodent vaginal microbiome across the estrous cycle and the effect of genital nerve electrical stimulation

et al. 2020

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Treatment options are limited for the approximately 40% of postmenopausal women worldwide who suffer from female sexual dysfunction (FSD). Neural stimulation has shown potential as a treatment for genital arousal FSD, however the mechanisms for its improvement are unknown. One potential cause of some cases of genital arousal FSD are changes to the composition of the vaginal microbiota, which is associated with vulvovaginal atrophy. The primary hypothesis of this study was that neural stimulation may induce healthy changes in the vaginal microbiome, thereby improving genital arousal FSD symptoms. In this study we used healthy rats, which are a common animal model for sexual function, however the rat vaginal microbiome is understudied. Thus this study also sought to examine the composition of the rat vaginal microbiota. Treatment rats (n = 5) received 30 minutes of cutaneous electrical stimulation targeting the genital branch of the pudendal nerve, and Control animals (n = 4) had 30-minute sessions without stimulation. Vaginal lavage samples were taken during a 14day baseline period including multiple estrous periods and after twice-weekly 30-minute sessions across a six-week trial period. Analysis of 16S rRNA gene sequences was used to characterize the rat vaginal microbiota in baseline samples and determine the effect of stimulation. We found that the rat vaginal microbiota is dominated by Proteobacteria, Firmicutes, and Actinobacteria, which changed in relative abundance during the estrous cycle and in relationship to each other. While the overall stimulation effects were unclear in these healthy rats, some Treatment animals had less alteration in microbiota composition between sequential samples than Control animals, suggesting that stimulation may help stabilize the vaginal microbiome. Future studies may consider additional physiological parameters, in addition to the microbiome composition, to further examine vaginal health and the effects of stimulation.

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Section: Plos Onementioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

The rodent vaginal microbiome across the estrous cycle and the effect of genital nerve electrical stimulation

et al. 2020

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“…Although recent studies have shown that TTNS is useful in the treatment of OAB symptoms, there is a limited number of studies examining its effect on SD. 10 There is only a single study reporting that the combination of TTNS and PFMT is effective in improving SD. 7 Clinical studies on SD are needed.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the effects of transcutaneous tibial nerve stimulation or pelvic floor muscle training on sexual dysfunction in female multiple sclerosis patients reporting overactive bladder

Dünya

Tülek

Kürtüncü

et al. 2021

Neurourology and Urodynamics

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Aims: Sexual dysfunction (SD) is common in female patients with multiple sclerosis (MS) reporting overactive bladder (OAB) symptoms. The aim of the study was to evaluate the effects of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on SD in female patients with MS reporting OAB symptoms. Methods: Patients with overactive bladder and SD were allocated to receive TTNS or PFMT daily. Overactive bladder symptoms, sexual functions, and sexual quality of life were assessed at baseline and 6 th weeks. Female Sexual Function Index (FSFI), Overactive Bladder Questionnaire (OABv-8), and Sexual Quality of Life-Female (SQoL-F) questionnaires were used. Results: Thirty patients (TTNS = 10, PFMT = 20) were included in the study.Compared to baseline, total FSFIOABv-8, and SQoL-F scores improved in both TTNS (p = 0.005, p = 0.011, p = 0.444, respectively) and PFMT (p = 0.002, p = 0.001, p = 0.001, respectively) groups. Between-group comparisons did not show any significant differences. Conclusion:This study demonstrates the efficacy of both TTNS and PFMT for improving sexual function in female MS patients with OAB symptoms, but did not show superiority of any particular method. Further studies are required to investigate the differences between these two non-invasive methods.

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“…Tibial nerve stimulation has been used clinically to treat pelvic organ disorders such as overactive bladder and fecal incontinence [6], and limited studies have shown potential for its use in treatment of reproductive-related disorders. Previous work in our laboratory showed that tibial nerve stimulation increases vaginal blood perfusion in intact anesthetized rats [7] and improves sexual dysfunction symptoms in humans (pilot study) [8]. However, these studies did not include a control group.…”

Section: Introductionmentioning

confidence: 99%

“…Previous work in our laboratory shows that tibial nerve stimulation has potential for treatment of sexual dysfunction symptoms. We demonstrated that tibial nerve stimulation increases vaginal blood perfusion (an indicator of sexual arousal in humans [11]), in intact anesthetized rats [9], and can also improve sexual dysfunction symptoms in humans (pilot study) [10]. However, these studies did not include a control group.…”

Section: Introductionmentioning

confidence: 99%

Tibial nerve stimulation increases vaginal blood perfusion and bone mineral density and yield load in ovariectomized rat menopause model

Zimmerman

Soriano

et al. 2021

Preprint

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Human menopause transition and post-menopausal syndrome, driven by reduced ovarian activity and estrogen levels, are associated with an increased risk for symptoms including but not limited to sexual dysfunction, metabolic disease, and osteoporosis. Current treatments (both hormonal and non-hormonal) are limited in efficacy and may have adverse consequences, so investigation for additional treatment options is necessary. Previous studies have demonstrated that tibial nerve stimulation or electro-acupuncture near the tibial nerve are minimally invasive treatments that increase vaginal blood perfusion or serum estrogen in the rat model. In this study we examined the effects of twice weekly tibial nerve stimulation (0.2 ms pulse width, 20 Hz, 2x motor threshold) under ketamine-xylazine anesthesia in ovariectomized (OVX) female Sprague Dawley rats on menopause-associated physiological parameters. Rats were split into three groups (n = 10 per group): 1) intact control (no stimulation), 2) OVX control (no stimulation), and 3) OVX stimulation (treatment group). Tibial nerve stimulation did not increase serum estradiol levels, but transiently increased vaginal blood perfusion during stimulation for up to 5 weeks after OVX and increased areal bone mineral density and yield load of the right femur (side of stimulation) compared to the unstimulated OVX control. Additional studies to elucidate the full potential of tibial nerve stimulation on menopause-associated symptoms under different experimental conditions are warranted.SummaryPercutaneous tibial nerve stimulation increases vaginal blood perfusion, areal bone mineral density, and femur yield load in an ovariectomized rat model of menopause.

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Transcutaneous Electrical Nerve Stimulation to Improve Female Sexual Dysfunction Symptoms: A Pilot Study

Abstract: This study provides evidence that transcutaneous stimulation of peripheral nerves has the potential to be a valuable therapeutic tool for women with FSD.

Cited by 17 publications

References 51 publications

The rodent vaginal microbiome across the estrous cycle and the effect of genital nerve electrical stimulation

The rodent vaginal microbiome across the estrous cycle and the effect of genital nerve electrical stimulation

Evaluating the effects of transcutaneous tibial nerve stimulation or pelvic floor muscle training on sexual dysfunction in female multiple sclerosis patients reporting overactive bladder

Tibial nerve stimulation increases vaginal blood perfusion and bone mineral density and yield load in ovariectomized rat menopause model

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