title: Management of sexual dysfunction due to central nervous system disorders: a systematic review.
abstract: OBJECTIVE
  To systematically review the management of sexual dysfunction due to central nervous system (CNS) disorders.
  
  
  METHODS
  The review was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified independently by two reviewers using electronic searches of MEDLINE and OVID (from January 2004 to August 2014) and hand searches of reference lists and review articles.
  
  
  RESULTS
  In patients with CNS disorders, neuro-urological assessment is recommended for both genders before starting any treatment for sexual dysfunction. For men, blood sexual hormones evaluation is the main investigation performed before phosphodiesterase type 5 inhibitors (PDE5Is) treatment, whereas there is no consensus on routine laboratory tests for women. PDE5Is are the first-line medical treatment for men, with the most robust data derived from patients with spinal cord injury assessed by validated questionnaires, mainly the International Index of Erectile Function-15. There is no effective medical treatment for sexual dysfunction in women. Sacral neuromodulation for lower urinary tract dysfunction may improve sexual dysfunction in both genders.
  
  
  CONCLUSIONS
  Although sexual dysfunction is a major burden for patients with CNS disorders, high-evidence level studies are rare and only available for PDE5Is treating erectile dysfunction. Well-designed prospective studies are urgently needed for both genders.
authors.affiliation: Neuro-Urology Department, Careggi University Hospital, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lombardi
authors.forename: Stefania
authors.initials: S
authors.lastname: Musco
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Li Marzi
authors.forename: Michele
authors.initials: M
authors.lastname: Lanciotti
authors.forename: Giulio
authors.initials: G
authors.lastname: Del Popolo
mesh_terms: D002493:Central Nervous System Diseases / Q000150:complications*; D002986:Clinical Trials as Topic; D004599:Electric Stimulation Therapy / Q000379:methods; D007172:Erectile Dysfunction / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009460:Neurologic Examination / Q000379:methods; D018377:Neurotransmitter Agents / Q000627:therapeutic use; D015917:Penile Prosthesis; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000628:therapy*
chemical_list: D018377:Neurotransmitter Agents; D058986:Phosphodiesterase 5 Inhibitors
keywords: neurogenic erectile dysfunction; neurogenic sexual dysfunction; phosphodiesterase type 5 inhibitors