Acute dorsal genital nerve stimulation increases subjective arousal in women with and without spinal cord injury: a preliminary investigation
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Abstract
Introduction
Female sexual dysfunction (FSD) impacts an estimated 40% of women. Unfortunately, female sexual function is understudied, leading to limited treatment options for FSD. Neuromodulation has demonstrated some success in improving FSD symptoms. We developed a pilot study to investigate the short-term effect of electrical stimulation of the dorsal genital nerve and tibial nerve on sexual arousal in healthy women, women with FSD, and women with spinal cord injury (SCI) and FSD.
Methods
This study consists of a randomized crossover design in three groups: women with SCI, women with non-neurogenic FSD, and women without FSD or SCI. The primary outcome measure was change in vaginal pulse amplitude (VPA) from baseline. Secondary outcome measures were changes in subjective arousal, heart rate, and mean arterial pressure from baseline. Participants attended one or two study sessions where they received either transcutaneous dorsal genital nerve stimulation (DGNS) or tibial nerve stimulation (TNS). At each session, a vaginal photoplethysmography sensor was used to measure VPA. Participants also rated their level of subjective arousal and were asked to report any pelvic sensations.
Results
We found that subjective arousal increased significantly from before to after stimulation in DGNS study sessions across all women. TNS had no effect on subjective arousal. There were significant differences in VPA between baseline and stimulation, baseline and recovery, and stimulation and recovery periods among participants, but there were no trends across groups or stimulation type. Two participants with complete SCIs experienced genital sensations.
Discussion
This is the first study to measure sexual arousal in response to acute neuromodulation in women. This study demonstrates that acute DGNS, but not TNS, can increase subjective arousal, but the effect of stimulation on genital arousal is inconclusive. This study provides further support for DGNS as a treatment for female sexual dysfunction.
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pudendal nerve stimulation
Recent efforts have attempted to understand the physical properties and functions of the peripheral mechanoreceptors in the genitalia (Krause corpuscles). This paper may be interesting to you, as it dives deeper into the molecular basis of what you're testing clinically: https://www.biorxiv.org/content/10.1101/2023.06.14.545006v1
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screened for eligibility
What is your definition of non-neurogenic FSD? When sexual dysfunction isn’t due to a lack of desire or fantasies as in HSDD? Even though the lubrication sub-score was used as an exclusion criteria, I’m curious if you believe it’s possible that you still included women with neurogenic FSD in this study? Would it have been useful to use DSM diagnostic criteria for HSDD to eliminate neurogenic FSD participants or is my understanding of neurogenic FSD different from yours in this case?
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method for delivering
Do you think the decision to decline to participate for 3 NDAB and 5 SCI participants also could have been due to hesitancy with DGNS?
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