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

Abstract

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.

Feasibility of Telerehabilitation-Based Pelvic Floor Muscle Training for Urinary Incontinence in People With Multiple Sclerosis: A Randomized, Controlled, Assessor-Blinded Study

“…When people do exercises under a physiotherapist's supervision, their commitment to exercise tends to increase. As stated in the previous studies conducted in people with multiple sclerosis, 27,29,30 we also did not observe any side effects or adverse events related to PFMT. The evidence for the feasibility and effects of Tele-PFMT is limited.…”

“…A previous study reported significant improvements in arousal, desire, and lubrication subdomains of sexual function after an 8-week PFMT 39. Another study in people with multiple sclerosis also showed improvements in sexual function after PFMT with electromyography biofeedback and/or electrical stimulation 29. The primary outcome measure in these studies was sexual dysfunction, only female participants were included, and a female-specific assessment tool was used to assess sexuality.…”

Pelvic Floor Dysfunctions and Their Rehabilitation in Multiple Sclerosis

“…Some studies investigated PFMT alone, with or without physiotherapist guidance [ 46 ], or PFMT in addition to other devices or methods, such as intravaginal neuromuscular electrical stimulation (NMES), electromyographic (EMG) biofeedback [ 49 , 50 ], transcutaneous tibial nerve stimulation (TTNS) [ 47 , 49 , 54 , 55 ].…”

“…Although with different study protocols, PFMT presents several advantages: it is associated with improvements in LUTS severity [ 45 , 46 , 47 , 48 ], QoL [ 45 , 46 , 52 ], level of anxiety and depression [ 52 ], and sexual dysfunctions [ 54 , 55 , 56 ].…”

Vibration or Transcutaneous Tibial Nerve Stimulation as a Treatment for Sexual Dysfunction in Women with Spinal Cord Injury: Study Protocol for a Randomized Clinical Trial

“…The literature shows improvements in SD in women through the application of genital vibration [14,15] or transcutaneous tibial nerve stimulation (TTNS) [16,17]. With respect to transcutaneous peripheral neuromodulation through the tibial nerve (L4-S3) [18], this presents an area of easy access to such nerve, which shares the same metameric area with the somatic and parasympathetic innervation of the pelvic floor (S2-S4) [19].…”