Is neuromodulation beneficial for patients with female sexual dysfunction?

Urology Times Journal, Vol 50 No 04, Volume 50, Issue 04

Although percutaneous tibial nerve stimulation (PTNS) is commonly used to treat overactive bladder, investigators continue to assess whether this neuromodulation technique is beneficial for patients with other urologic conditions.

For instance, a recent study presented at the 2022 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting, evaluated the safety and efficacy of PTNS in patients who suffer from female sexual dysfunction.1 In this interview, co-author Varun R. Talanki, MD, discusses the objectives and findings of this study and what they mean for future management of female sexual dysfunction. Talanki is a urologist at Trivalley Urology in Murrieta, California.

Please summarize the main points of your presentation.

My SUFU presentation was on the treatment of female sexual dysfunction with percutaneous tibial nerve stimulation. This was a project that we developed after a grant that we got from SUFU when I was a resident at Stony Brook in New York. Female sexual dysfunction is characterized by lack of sexual arousal, and sometimes even pain with sexual activity. Female sexual dysfunction has many factors that can contribute to it, so this makes it very difficult to treat. There are multiple medications as well as non-medical therapies that can help. And so, we were studying to see if percutaneous tibial nerve stimulation would be a good treatment for female sexual dysfunction. We did a randomized control trial, where we compared percutaneous tibial nerve stimulation to a validated sham. We actually found that treatment with percutaneous tibial nerve stimulation was a safe and very effective way of improving sexual function. We treated women weekly over 12 weeks, and found that a fair proportion of these women converted from having sexual dysfunction to no longer having sexual dysfunction. That was an incredible finding that mimics some other research that does exist. Our study was the first randomized controlled trial to show these results.

Do you currently offer PTNS in your own practice? Why or why not?

We actually do offer it and I offer it to all my patients that come in with overactive bladder. It's really a safe and effective treatment. It is approved; patients can get good coverage for it. And I think it's a very favorable procedure because patients don't have to undergo surgery, there's no medications that are involved.

What other innovations in the space of female sexual dysfunction are on the horizon right now?

There's constant research that's being done looking at the different pathways. There are different hormonal pathways that are being studied actively. We have a few now that are FDA approved; however, as we get a better understanding of these pathways, we can start developing new drugs to target them.

Is there anything else you feel our audience should know about this certain topic?

I think one of the main difficulties with dealing with female sexual dysfunction is that it's underreported. I think that as providers, we can do a better job of screening for it and asking our patients if they have any of the risk factors or any of the signs or symptoms that can contribute to female sexual dysfunction. We need to really take a stand and screen for it, as it really can affect our patients. And then, at the same time, we have to create a culture where patients feel that they can bring it up. Make sure you give patients time and create a setting where they are willing to talk about it.

Reference

1. Talanki VR. Efficacy of percutaneous tibial nerve stimulation (PTNS) in the treatment of female sexual dysfunction. Presented at the 2022 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting; February 22-26, 2021; San Diego, California.