The effect of percutaneous tibial nerve stimulation (PTNS) on sexual function: a systematic review and meta-analysis

Introduction Percutaneous tibial nerve stimulation (PTNS) is now an established treatment of pelvic floor dysfunction such as overactive bladder, faecal incontinence or voiding dysfunction. Prevalence of female sexual dysfunction is high in this group. We aim to examine the effect of PTNS on sexual function in this patient group by systematically reviewing the literature and pooling the data in a meta-analysis. Methods The literature search was conducted using the MEDLINE, Embase and CINAHL databases. Initial results yielded 74 citations. From these, nine articles met our inclusion criteria. Two articles were doubly reported, leaving seven studies in the systematic review. Only four studies reported sufficient information to be included in our meta-analysis. Results Three studies were randomised controlled trials, and five were before-after studies. The number of participants in each study ranged from 11 to 220. Four out 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 (p = 0.04, SMD -0.41, CI[-0.79, -0.03], I-2 = 0%). In a subgroup analysis of the bowel domain of sexual function, there was a significant improvement with PTNS (p = 0.03, MD 17.7, CI [1.92, 33.47], I-2 = 0%). Conclusion We report a systematic review on the effect of PTNS on sexual function. Although the studies are of small size, the results are promising in terms of a positive effect of PTNS on sexual function, and we recommend further research in this area.