The Effects of Transcutaneous Tibial Nerve Stimulation on Female Sexual Function in Multiple Sclerosis Patients: A Narrative Review.

Female sexual dysfunction (FSD) is prevalent among women with multiple sclerosis (MS), leading to significant impairments in quality of life. Despite various available treatments, current approaches often fail to address the complex, multifactorial nature of FSD in this population. Transcutaneous tibial nerve stimulation (TTNS) has recently gained attention as a non-invasive neuromodulation therapy that has demonstrated potential benefits for neurogenic bladder dysfunction, with preliminary evidence suggesting overlapping improvements in sexual function. This narrative review synthesizes current evidence on the use of TTNS for managing FSD in women with MS. A comprehensive literature search of Medline, Web of Science, and Scopus was conducted, focusing on studies that explored TTNS interventions and outcomes in MS-related FSD. The findings indicate that TTNS likely modulates pelvic neural pathways, enhances genital blood flow, and improves key sexual function domains, including arousal, lubrication, and orgasm. Clinical studies using validated assessment tools, such as the Female Sexual Function Index (FSFI), have shown significant improvements in sexual outcomes, particularly when TTNS is combined with pelvic floor muscle training (PFMT). Experimental models further support the plausibility of these findings, linking TTNS to increased pelvic perfusion and more balanced neurogenic regulation of sexual response. Although initial evidence suggests that TTNS is safe, effective, and well-tolerated, limitations include small sample sizes, short follow-up periods, and variability in treatment protocols. Future research should focus on larger controlled trials, long-term follow-up studies, and standardized intervention parameters to optimize the application of TTNS for addressing FSD in women with MS.