The effect of transcutaneous electrical stimulation treatment in combination with intraoperative nerve staining on sexual function after radical hysterectomy: a pilot study

Objective: Cervical cancer treatment by radical hysterctomy is usually associated with sexual dysfunction. The aim of the study was to evaluate the effect of transcutaneous electrical stimulation treatment in combination with intraoperative nerve staining on sexual function after radical surgery. Methods: Eligible patients (n = 88) who had undergone laparoscopic nerve sparing radical hysterectomy (Type C1, nerve sparing radical hysterectomy, NSRH), pelvic lymphedenectomy, vaginal extension and ovarian transposition were recruited in the study and allocated (no random assignment) to four groups. Group 1 (biofeedback) received a short-term bio-feedback transcutaneous electrical stimulation treatment after surgery. Group 2 (NSRH) received NSRH with intraoperative nerve staining. Group 3 (electrical) received transcutaneous electrical stimulation after surgery combined with intraoperative nerve staining. Group 4 (placebo) did not receive either transcutaneous electrical stimulation after the surgery or intraoperative nerve staining. Sexual function of the patients and their partners were evaluated using the Female Sexual Function Index (FSFI) 3 months after completion of treatment. Six domains were assessed: desire, arousal, lubrication, orgasm, satisfaction and pain, while the visual analog score (VAS) was used to evaluate partner satisfaction. Results: On average, overall sexual function reduced from baseline to 3-month follow-up for Groups 1 (biofeedback), 2 (NSRH) and 4 (placebo) . In Group 1, all domain scores reduced from baseline to 3-month follow-up. In Group 2, reductions were observed in desire, arousal and orgasm domains. In Group 3 (electrical) there were no reductions observed in any domains, while in Group 4 reductions were observed in desire, arousal, orgasm and pain. The results revealed that there was no statistical difference between group 2, 3 and 4 in lubrication and satisfaction domains. And there were no statistical difference between group 2 and 3 in pain domain. For the patient partner satisfaction, the difference between baseline and 3 months after treatments of group 3 was significantly lower than the other three groups. And the differences of group 2 and 4 were significantly lower than group 1 respectively. Conclusions: The use of transcutaneous electrical stimulation treatment combined with intraoperative nerve staining could improve the sexual function for the patients and the enhance sexual satisfaction for their partners after radical hysterectomy.

Transcutaneous electrical stimulation; Radical hysterectomy; Sexual function.

[1] Ferlay J., Shin H.R., Bray F., Forman D., Mathers C., Parkin D.M.: “Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008”. Int. J. Cancer., 2010, 127, 2893.

[2] Jemal A., Bray F., Center M.M., Ferlay J., Ward E., Forman D.: “Global cancer statistics”. CA. Cancer. J. Clin., 2011, 61, 69.

[3] Petignat P., Roy M.: “Diagnosis and management of cervical cancer”. B. M. J., 2007, 335, 765.

[4] Aerts L., Enzlin P., Verhaeghe J., Poppe W., Vergote I., Amant F.: “Long-term sexual functioning in women after surgical treatment of cervical cancer stages IA to IB: a prospective controlled study”. Int. J. Gynecol. Cancer., 2014, 24, 1527.

[5] Donovan K.A., Taliaferro L.A., Alvarez E.M., Jacobsen P.B., Roetzheim R.G., Wenham R.M.: “Sexual health in women treated for cervical cancer: characteristics and correlates”. Gynecol. Oncol., 2007, 104, 428.

[6] Vrzackova P., Weiss P., Cibula D.: “Sexual morbidity following radical hysterectomy for cervical cancer”. Expert. Rev. Anticancer. Ther., 2010, 10, 1037.

[7] Song T., Choi C.H., Lee Y.Y., Kim T.J., Lee J.W., Kim B.G.,et al.: “Sexual function after surgery for early-stage cervical cancer: is there a difference in it according to the extent of surgical radicality ?” J. Sex. Med., 2012, 9, 1697.

[8] Zhang X., Jia L., Tao X., Ding J., Hua K.: “Intraoperative nerve staining in nerve-sparing radical hysterectomy: a pilot study”. Arch.Gynecol. Obstet., 2017, 295, 737.

[9] Aydın S., Arıoğlu Aydın Ç., Batmaz G., Dansuk R.: “Effect of vaginal electrical stimulation on female sexual functions: a randomized study”. J. Sex. Med., 2015, 12, 463.

[10] Jha S., Walters S.J., Bortolami O., Dixon S., Alshreef A.: “Impact of pelvic floor muscle training on sexual function of women with urinary incontinence and a comparison of electrical stimulation versus standard treatment (IPSU trial): a randomisedcontrolled trial”. Physiotherapy., 2018, 104, 91.

[11] Lúcio A.C., DAncona C.A., Lopes M.H., Perissinotto M.C., Damasceno B.P.: “The effect of pelvic floor muscle training alone or in combination with electrostimulation in the treatment of sexual dysfunction in women with multiple sclerosis”. Mult. Scler., 2014, 20, 1761.

[12] Sun X.L., Wang H.B., Wang Z.Q., Cao T.T., Yang X., Han J.S., et al.: “Effect of transcutaneous electrical stimulation.treatment on lower urinary tract symptoms after class III radical hysterectomy in cervical cancer patients: study protocol for a multicentre, randomized controlled trial”. BMC. Cancer., 2017, 17, 416.

[13] Plotti F., Nelaj E., Sansone M., Antonelli E., Altavilla T., Angioli R., et al.: “Sexual function after modified radical hysterectomy (Piver II/Type B) vs. classic radicalhysterectomy (Piver III/Type C2) for early stage cervical cancer. A prospective study”. J. Sex.Med., 2012, 9, 909.

[14] Bogani G., Serati M., Nappi R., Cromi A., di Naro E., Ghezzi F.: “Nerve-sparing approach reduces sexual dysfunction in patients undergoing laparoscopic radical hysterectomy”. J. Sex. Med., 2014, 11, 3012.