Table 1. Summary of results of our systematic review.
| Sexual dysfunction | Authors | Year of publication | Method | Subjects | Results | Recommendation/Conclusion |
|---|---|---|---|---|---|---|
| Persistent genital arousal disorder (PGAD) | Gaines et al. | 2017 | Previously and unsuccessfully treated women, treated with chronic pudendal neuromodulation (CPN) | 6 | 4/6 completed the survey and 3/4 reported relief of their symptoms | CPN may be an effective treatment for PGAD. More studies are needed |
| Persistent genital arousal disorder (PGAD) | Klifto et al. | 2019 | Previously and unsuccessfully treated women, who stopped every activity that might cause pudendal nerve compression. All treated with neurolysis of the dorsal branch of the pudendal nerve | 8 | Complete response in 7/8 patient who were treated bilaterally, partial response in the only patient treated unilaterally | Compression of the pudendal nerve is a cause of PGAD. Decompression of the pudendal nerve relieves the symptoms of PGAD. Bilateral decompression achieves better results than unilateral decompression |
| Erectile dysfunction (ED) | Shafik | 1994 | Pudendal canal decompression using a para anal incision in patients with neurogenic ED | 7 | Improvement of ED in 6/7 patients after 3 to 6 months | Pudendal canal syndrome is a cause of neurogenic ED. Open surgical decompression of the pudendal nerve improves ED |
| Erectile dysfunction (ED) | Shafik | 1995 | Pudendal canal decompression using a para anal incision in patients with arteriogenic and neurogenic ED | 10 | 6/10 patients had pure arteriogenic ED, decompression resulted in improvement of ED | Pudendal artery or nerve entrapment is a cause of ED. The 2 may be affected simultaneously Open surgical decompression of the pudendal artery and nerve improves ED |
| 4/10 patients had arteriogenic and neurogenic ED, decompression resulted in improvement of ED in 2/4 patients | ||||||
| Erectile dysfunction (ED) | Klifto et al. | 2020 | Surgical decompression of the dorsal branch of the pudendal nerve in patients with loss of penile sensation, painful penis and ED following dorsal branch injury | 7 | 3 patients had ED | ED secondary to injury of the dorsal branch of the penis can be treated with open surgical neurolysis |
| 2/3 patients with ED restored a normal erection after a mean follow-up of 57 weeks | ||||||
| Erectile dysfunction (ED) | Aoun et al. | 2020 | Laparoscopic transperitoneal pudendal nerve and artery decompression in patients with ED and a history of pudendal nerve entrapment | 5 | Significant improvement of the IIEF-5 and the EHS in all patients after 3 months of follow-up | Pudendal nerve and artery entrapment is a reversible cause of ED. Laparoscopic transperitoneal pudendal nerve and artery decompression is a safe and effective treatment of ED due to pudendal nerve and artery entrapment |
| Premature ejaculation (PE) | Basal et al. | 2010 | PRF neuromodulation of the dorsal penile nerves in patient with PE (without ED) that was resistant to conventional treatments | 15 | Significant increase of the IELT and the SSS after 3 weeks of the procedure in all patients | PRF is an effective treatment of PE yet placebo controlled studies and objective tools are needed |
| Premature ejaculation (PE) | Luo et al. | 2007 | Dorsal nerve neurotomy using a penile incision under local anesthesia in patients with PE without ED | 19 | 15/19 patient reported significant improvement of the intravaginal ejaculation latency and the satisfaction degree of intercourse. | Penile dorsal nerve neurotomy is an effective treatment for PE without ED, but further studies are needed |
| Premature ejaculation (PE) | Shi et al. | 2008 | Selective resection of the branches of the two dorsal penile nerves as a treatment for PPE | 483 | Decreased penile sensation was noted inn all patients and prolonged ejaculation latency was noted in 352/483 patients | Selective resection of the branches of the two dorsal penile nerves, which can definitely reduce the sensitivity of the penis, is a safe and effective surgical option for the treatment of PPE |
| Premature ejaculation (PE) | Zhang et al. |
2012 | Penile dorsal nerve neurotomy for PE, by maintaining only two branches | 146 | Objective assessment using the VPT test | VPT is a non-invasive, objective, and safe approach for dorsal penile nerve sensory detection. Penile dorsal nerve neurotomy can be applied for treating PE |
| 75/146 cured | ||||||
| 34/146 improved | ||||||
| 37/146 ineffective | ||||||
| Total effective rate of 75% | ||||||
| Premature ejaculation (PE) | Yong et al. | 2012 | Selective dorsal penile nerve rhizotomy joint preputial frenulum thread burial for PE under local anesthesia | 330 | IELT improved from 0.75 minutes to 4.75 minutes | Selective dorsal penile nerve rhizotomy joint preputial frenulum thread burial therapy is an effective treatment for primary premature ejaculation |
| Intercourse satisfaction improved from 47% to 93% | ||||||
| 242/330 cured | ||||||
| 72/330 improved | ||||||
| 16/330 invalid | ||||||
| Total effective rate 95.2% | ||||||
| Premature ejaculation (PE) | Aoun et al. | 2020 | CT-guided pudendal nerve block at the sacrospinous ligament and the Alcock’s canal with ropivacaine and methylprednisone | 5 | IELT, IIEF-5, PEDT and SQol-M questionnaire significantly improved after treatment | CT-guided pudendal nerve block at the sacrospinous ligament and the Alcock’s canal is an effective treatment for sensory PE |
| Premature ejaculation (PE) | Jian-hua et al. | 2012 | 3 groups: -selective α1-adrenergic receptor blocker | 89 | IELT was significantly improved in the combination therapy group compared to the other groups | Dorsal penile nerve amputation surgery combined with α1-adrenergic receptor blocker is an effective treatment for PE |
| -dorsal penile nerve amputation surgery | ||||||
| -combination therapy | ||||||
| Vestibulodynia | Rapkin et al. | 2008 | Five sessions of caudal epidural, pudendal nerve block, and vestibular infiltration of local anesthetic agents | 27 | Vulvalgesiometer (objective measure): improvement in pain threshold (41%) and tolerance (51%) | Nerve block for vulvar vestibulitis is effective. Placebo-controlled study is needed |
| Self-report questions (subjective measure): 57% improvement | ||||||
| Postmenopausal women less improvement than premenopausal women | ||||||
| Vestibulodynia | Vallinga et al. | 2015 | TENS was used for PVD. Assessment with self-report questionnaires and visual analog scales at baseline (T1), post-TENS (T2), and follow-up (T3) | 39 | Vulvar pain at T2 and T3 significantly lower than at baseline | TENS is a feasible and effective treatment for therapy-resistant TENS. TENS reduced the need for vestibulectomy |
| Sexual functioning scores and sexually-related personal distress scores had significantly improved post TENS | ||||||
| Vestibulodynia | Murina et al. | 2008 | RCT: 20 treatment sessions of TENS versus sham treatment for vestibulodynia | 40 | Significant improvement of the VAS and the SFMPQ in the active TENS group but not in the placebo group | TENS is a simple, effective and safe short-term treatment for the management of vestibulodynia |
| Vestibulodynia | Murina et al. | 2018 | RCT: vagianal diazepam + TENS vs. placebo + TENS for vestibulodynia | 42 | The VAS score significantly decreased in the two groups | Vaginal diazepam plus TENS is useful to improve pain and pelvic floor muscle instability in women with vestiulodynia |
| The Marinoff dyspareunia scores and the ability to relax the pelvic floor muscle after contraction were significantly greater for the diazepam group vs. the placebo group |
PGAD, persistent genital arousal disorder; ED, erectile dysfunction; CPN, chronic pudendal neuromodulation; IIEF-5, international Index for Erectile Function; EHS, erectile hardness score; PE, premature ejaculation; PPE, primary premature ejaculation; PRF, pulsed radiofrequency; IELT, intravaginal ejaculatory latency time; SSS, sexual satisfaction score; VPT, vibration sensory threshold; PEDT, premature ejaculation diagnostic tool; SQoL-M, Sexual Quality of Life–Male version; TENS, transcutaneous electrical nerve stimulation; PVD, provoked vestibulodynia; RCT, randomized controlled trial; VAS, visual analogue scale; SF-MPQ, McGill–Melzack pain questionnaire.