TY - JOUR
AU1 - Dubinskaya, Alexandra
AU2 - Horwitz, Rainey
AU3 - Scott, Victoria
AU4 - Anger, Jennifer
AU5 - Eilber, Karyn
AB - Abstract Introduction Vibrators and similar devices are an underutilized treatment modality in pelvic and sexual medicine, likely because of the limited knowledge on the health benefits of their use. Objectives The aim of this study was to review available data regarding the effect of vibrator use on sexual function, pelvic floor function, and chronic unexplained vulvar pain. Methods We performed a systematic literature review of PubMed, Embase, and MEDLINE from inception to March 2021 per the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). The search was based on the following keywords: sex toy woman, pelvic vibrator, sexual stimulation vibrator, vaginal vibrator, vibrator pelvic floor, vibrator incontinence, and vulvar pain vibrator. An overall 586 articles were identified. Studies that met inclusion criteria were reviewed: original research, sample of women, vibrator use, and application to the pelvic/genital area. Exclusion criteria included case reports, unrelated content, vibrator not applied to the pelvic/genital area, male participants, or conditions of interest not addressed. A total of 17 original studies met the criteria and were reviewed in depth. Results After review of the literature and identification of articles appropriate for the study, there were 8 studies surrounding sexual function, 8 on pelvic floor function (muscle strength/urinary incontinence), and 1 on vulvar pain. Among the identified studies, vibrators were considered an accepted modality to enhance a woman’s sexual experience, improve pelvic floor muscle function, and facilitate treatment of vulvar pain. Conclusions Vibrators are not well studied, and given the promising benefits demonstrated in the articles identified, future research efforts should be directed toward investigating their utility. Considering the potential pelvic health benefits of vibrators, their recommendation to women could be included in our pelvic floor disorder treatment armamentarium. vibrator, novelty toy, enhancement device, female sexual health, female sexual dysfunction, pelvic floor, sexuality, vulvar pain, vulvodynia Introduction Vibration therapy has been used for a variety of applications, including “whole body vibration”2 and local vibration.2 Whole body vibration has been utilized in the context of exercising and bone health and has been shown to improve muscle strength and performance as well as prevent bone resorption by facilitating bone regeneration.3 Local application of vibration to the pelvic area has been used for pelvic health and sexual health, which are often intertwined. In the context of pelvic health, local vibration can be applied to train pelvic floor muscles as an element of pelvic rehabilitation.4 Pelvic floor dysfunction, urinary incontinence, and vulvodynia are common conditions that can affect an individual’s quality of life and relationships. Multiple commercially available vibrating devices claim to improve pelvic health. In the context of sexual health, vibration can be applied to external genitalia with the goal to provide sexual stimulation and orgasm. Vibrators are generally considered to be sex enhancement devices as they can augment and improve individual sexual function. As such, knowledge about potential vibrator effects on each domain of the sexual response cycle can help facilitate their use to improve sexual health. The data regarding the health benefits of vibration on the genital area and/or pelvic floor are limited. In the modern era, this information primarily comes from companies that produce and sell sex toys, pelvic floor training devices, and sex education material. Because of the potential benefits for pelvic and sexual health, there is a need for the medical community to increase awareness regarding the use of vibrating devices and their utilization as part of a comprehensive treatment plan for certain pelvic floor disorders and sexual dysfunction. Unfortunately, physicians are not routinely trained in the use of vibrating devices or their medical benefits; thus, vibrators are less likely to be discussed with patients.5-7 The aim of this study was to review the existing literature on the benefits of vibrators and their prototypes on genitourinary, pelvic, and sexual health. For the purpose of this review, the terms vibrator and local vibration are used interchangeably to describe vibrating devices designed for sexual pleasure, pelvic floor muscle exercise, and fertility treatments. Figure 1 Open in new tabDownload slide PRISMA diagram. Methods We performed a systematic review of the literature following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). The primary sources of information were PubMed, Embase, and MEDLINE. The literature search aimed to identify randomized controlled trials, cohort studies (prospective and retrospective), surveys, and literature reviews that evaluated the various health benefits of commercial vibrators on sexual function, pelvic floor dysfunction, and vulvar pain. Eight search terms were utilized: sex toy woman, pelvic vibrator, sexual stimulation vibrator, vaginal vibrator, vibrator pelvic floor, vibrator incontinence, vulvodynia vibrator, and vulvar pain vibrator. The queried results were screened according to the following criteria: original research (randomized controlled trials, cohort studies, systematic reviews), sample based on biological women, and vibrator/vibration applied to the pelvic/genital area. The studies were excluded if they did not address conditions of interest (sexual health, pelvic floor disorders, chronic unexplained vulvar pain), the vibrator was not applied to the pelvic/genital region, participants were biological men, or the article was not written in English. Incomplete trials, case reports, and duplicated results were also excluded from the analysis. Two independent reviewers evaluated each study in detail (Figure 1). Results Of 586 articles identified, only 17 met inclusion criteria. Studies consisted of literature reviews, interviews, prospective case-control studies, cohort studies, surveys, and randomized clinical trials (Tables 1 and 2). The number of articles addressing the outcomes of interest were as follows: 8 articles on sexual function, 8 on pelvic floor dysfunction (muscles strength/urinary incontinence), and 1 on vulvodynia (chronic unexplained vulvar pain). Table 1 Studies included in the systematic review. a Author . Study design . No. of female participantsb . Age, y, mean (range) . Outcome measure . Application site . Sexual function outcomes . Pelvic floor outcomes . Vulvar pain outcomes . Rullo (2018)10 Narrative review Review of literature ↑ Desire ↑ Arousal ↑ Orgasm ↑ Sexual enjoyment ↓ Pain Guess (2017)19 Single-arm prospective cohort 70 FSFI, FSDS, FIEI, QST ↑ Desire ↑ Arousal ↑ Orgasm ↑ Satisfaction ↓ Vibratory threshold ↓ Distress Marcus (2011)20 Prospective cohort, interviews 17 38 (23-55) Interview responses ↑ Orgasm Herbenick (2011)22 Interviews, survey 2056/53 41 (18-60) Interview responses, survey responses, FSFI ↑ Desire ↑ Arousal ↑ Orgasm ↑ Satisfaction ↓ Pain Herbenick (2010)35 Survey 2051 41 (18-60) FSFI, survey responses ↑ Desire ↑ Arousal ↑ Orgasm ↓ Pain Struck (2008)23 Retrospective analysis 500 35 (18-88) Occurrence of orgasm (subjective/objective) External ↑Occurrence of orgasm Sipski (2005)21 Cross-sectional 57 18-51 Heart rate, VPA, subjective arousal (vibratory vs manual stimulation) External ↑ Heart rate ↑ VPA ↑ Subjective arousal Davis (1996)9 Questionnaires 202 18-75 Questionnaire responses Both ↑ Orgasm (quality and quantity) Descriptive user information Thomas (2021)2 Analysis of online products reviews 1168 Reviews on Amazon.com Internal ↑ Sexual function ↑Urinary incontinence control Barassi (2019)30 Prospective cohort 60 59 (53-65) PFDI-20, PFIQ-7, myometric parameters External ↑Urinary incontinence control ↑ Pelvic floor muscle strength Rodrigues (2019)28 Randomized clinical trial 18/17 58 (56-60) PFM function on examination Internal ↑ Pelvic floor muscle contraction strength Nilsen (2018)29 Prospective cohort 60 44 (36-54) ICIQ-SF, pad stress test Intravaginal ↓ Pad stress test Rodrigues (2018)27 Systematic review UDI-6, IIQ-7, FSDS-R, Oxford Scale, 1-h pad test External ↑Pelvic floor muscle strength ↓SUI de la Torre (2017)4 Prospective case series 48 46 (32-59) 1-h pad test, pelvic floor assessment (Oxford Scale), UDI-6, IIQ-7, FSFI, FSDS-R Intravaginal ↓ Sexual distress ↓ Pad stress test ↓ SUI ↑ Pelvic floor muscle strength Ong (2015)32 Randomized clinical trial 40 50-53 APFQ, pelvic floor assessment (Likert-type scale) Internal ↓ SUI ↑ Pelvic floor muscle strength Sønksen (2007)31 Prospective pilot study 33 19-44 No. of incontinence episodes, pads External ↑Urinary incontinence control Zolnoun (2008)33 Survey 49 30 (19-68) Survey External VVT is acceptable treatment ↓ Pain ↑ Enjoyment Author . Study design . No. of female participantsb . Age, y, mean (range) . Outcome measure . Application site . Sexual function outcomes . Pelvic floor outcomes . Vulvar pain outcomes . Rullo (2018)10 Narrative review Review of literature ↑ Desire ↑ Arousal ↑ Orgasm ↑ Sexual enjoyment ↓ Pain Guess (2017)19 Single-arm prospective cohort 70 FSFI, FSDS, FIEI, QST ↑ Desire ↑ Arousal ↑ Orgasm ↑ Satisfaction ↓ Vibratory threshold ↓ Distress Marcus (2011)20 Prospective cohort, interviews 17 38 (23-55) Interview responses ↑ Orgasm Herbenick (2011)22 Interviews, survey 2056/53 41 (18-60) Interview responses, survey responses, FSFI ↑ Desire ↑ Arousal ↑ Orgasm ↑ Satisfaction ↓ Pain Herbenick (2010)35 Survey 2051 41 (18-60) FSFI, survey responses ↑ Desire ↑ Arousal ↑ Orgasm ↓ Pain Struck (2008)23 Retrospective analysis 500 35 (18-88) Occurrence of orgasm (subjective/objective) External ↑Occurrence of orgasm Sipski (2005)21 Cross-sectional 57 18-51 Heart rate, VPA, subjective arousal (vibratory vs manual stimulation) External ↑ Heart rate ↑ VPA ↑ Subjective arousal Davis (1996)9 Questionnaires 202 18-75 Questionnaire responses Both ↑ Orgasm (quality and quantity) Descriptive user information Thomas (2021)2 Analysis of online products reviews 1168 Reviews on Amazon.com Internal ↑ Sexual function ↑Urinary incontinence control Barassi (2019)30 Prospective cohort 60 59 (53-65) PFDI-20, PFIQ-7, myometric parameters External ↑Urinary incontinence control ↑ Pelvic floor muscle strength Rodrigues (2019)28 Randomized clinical trial 18/17 58 (56-60) PFM function on examination Internal ↑ Pelvic floor muscle contraction strength Nilsen (2018)29 Prospective cohort 60 44 (36-54) ICIQ-SF, pad stress test Intravaginal ↓ Pad stress test Rodrigues (2018)27 Systematic review UDI-6, IIQ-7, FSDS-R, Oxford Scale, 1-h pad test External ↑Pelvic floor muscle strength ↓SUI de la Torre (2017)4 Prospective case series 48 46 (32-59) 1-h pad test, pelvic floor assessment (Oxford Scale), UDI-6, IIQ-7, FSFI, FSDS-R Intravaginal ↓ Sexual distress ↓ Pad stress test ↓ SUI ↑ Pelvic floor muscle strength Ong (2015)32 Randomized clinical trial 40 50-53 APFQ, pelvic floor assessment (Likert-type scale) Internal ↓ SUI ↑ Pelvic floor muscle strength Sønksen (2007)31 Prospective pilot study 33 19-44 No. of incontinence episodes, pads External ↑Urinary incontinence control Zolnoun (2008)33 Survey 49 30 (19-68) Survey External VVT is acceptable treatment ↓ Pain ↑ Enjoyment Abbreviations: APFQ, Australian Pelvic Floor Questionnaire; FIEI, Female Interventional Efficacy Index; FSDS, Female Sexual Distress Scale; FSDS-R, Female Sexual Distress Scale–Revised; FSFI, Female Sexual Function Index; ICIQ-SF, Incontinence Questionnaire–Short Form; IIQ-7, Incontinence Impact Questionnaire–Short Form; PFDI–20, Pelvic Floor Disability Index–20; PFIQ-7, Pelvic Floor Impact Questionnaire–7; PFM, pelvic floor muscle; QST, quantitative sensory testing; SUI, stress urinary incontinence; UDI-6, Urinary Distress Inventory–Short Form; VPA, vaginal pulse amplitude; VVT, vulvar vibration therapy. a Blank cells indicate not applicable/available. b Values formatted with a slash (2056/53 and 18/17) indicate . Open in new tab Table 1 Studies included in the systematic review. a Author . Study design . No. of female participantsb . Age, y, mean (range) . Outcome measure . Application site . Sexual function outcomes . Pelvic floor outcomes . Vulvar pain outcomes . Rullo (2018)10 Narrative review Review of literature ↑ Desire ↑ Arousal ↑ Orgasm ↑ Sexual enjoyment ↓ Pain Guess (2017)19 Single-arm prospective cohort 70 FSFI, FSDS, FIEI, QST ↑ Desire ↑ Arousal ↑ Orgasm ↑ Satisfaction ↓ Vibratory threshold ↓ Distress Marcus (2011)20 Prospective cohort, interviews 17 38 (23-55) Interview responses ↑ Orgasm Herbenick (2011)22 Interviews, survey 2056/53 41 (18-60) Interview responses, survey responses, FSFI ↑ Desire ↑ Arousal ↑ Orgasm ↑ Satisfaction ↓ Pain Herbenick (2010)35 Survey 2051 41 (18-60) FSFI, survey responses ↑ Desire ↑ Arousal ↑ Orgasm ↓ Pain Struck (2008)23 Retrospective analysis 500 35 (18-88) Occurrence of orgasm (subjective/objective) External ↑Occurrence of orgasm Sipski (2005)21 Cross-sectional 57 18-51 Heart rate, VPA, subjective arousal (vibratory vs manual stimulation) External ↑ Heart rate ↑ VPA ↑ Subjective arousal Davis (1996)9 Questionnaires 202 18-75 Questionnaire responses Both ↑ Orgasm (quality and quantity) Descriptive user information Thomas (2021)2 Analysis of online products reviews 1168 Reviews on Amazon.com Internal ↑ Sexual function ↑Urinary incontinence control Barassi (2019)30 Prospective cohort 60 59 (53-65) PFDI-20, PFIQ-7, myometric parameters External ↑Urinary incontinence control ↑ Pelvic floor muscle strength Rodrigues (2019)28 Randomized clinical trial 18/17 58 (56-60) PFM function on examination Internal ↑ Pelvic floor muscle contraction strength Nilsen (2018)29 Prospective cohort 60 44 (36-54) ICIQ-SF, pad stress test Intravaginal ↓ Pad stress test Rodrigues (2018)27 Systematic review UDI-6, IIQ-7, FSDS-R, Oxford Scale, 1-h pad test External ↑Pelvic floor muscle strength ↓SUI de la Torre (2017)4 Prospective case series 48 46 (32-59) 1-h pad test, pelvic floor assessment (Oxford Scale), UDI-6, IIQ-7, FSFI, FSDS-R Intravaginal ↓ Sexual distress ↓ Pad stress test ↓ SUI ↑ Pelvic floor muscle strength Ong (2015)32 Randomized clinical trial 40 50-53 APFQ, pelvic floor assessment (Likert-type scale) Internal ↓ SUI ↑ Pelvic floor muscle strength Sønksen (2007)31 Prospective pilot study 33 19-44 No. of incontinence episodes, pads External ↑Urinary incontinence control Zolnoun (2008)33 Survey 49 30 (19-68) Survey External VVT is acceptable treatment ↓ Pain ↑ Enjoyment Author . Study design . No. of female participantsb . Age, y, mean (range) . Outcome measure . Application site . Sexual function outcomes . Pelvic floor outcomes . Vulvar pain outcomes . Rullo (2018)10 Narrative review Review of literature ↑ Desire ↑ Arousal ↑ Orgasm ↑ Sexual enjoyment ↓ Pain Guess (2017)19 Single-arm prospective cohort 70 FSFI, FSDS, FIEI, QST ↑ Desire ↑ Arousal ↑ Orgasm ↑ Satisfaction ↓ Vibratory threshold ↓ Distress Marcus (2011)20 Prospective cohort, interviews 17 38 (23-55) Interview responses ↑ Orgasm Herbenick (2011)22 Interviews, survey 2056/53 41 (18-60) Interview responses, survey responses, FSFI ↑ Desire ↑ Arousal ↑ Orgasm ↑ Satisfaction ↓ Pain Herbenick (2010)35 Survey 2051 41 (18-60) FSFI, survey responses ↑ Desire ↑ Arousal ↑ Orgasm ↓ Pain Struck (2008)23 Retrospective analysis 500 35 (18-88) Occurrence of orgasm (subjective/objective) External ↑Occurrence of orgasm Sipski (2005)21 Cross-sectional 57 18-51 Heart rate, VPA, subjective arousal (vibratory vs manual stimulation) External ↑ Heart rate ↑ VPA ↑ Subjective arousal Davis (1996)9 Questionnaires 202 18-75 Questionnaire responses Both ↑ Orgasm (quality and quantity) Descriptive user information Thomas (2021)2 Analysis of online products reviews 1168 Reviews on Amazon.com Internal ↑ Sexual function ↑Urinary incontinence control Barassi (2019)30 Prospective cohort 60 59 (53-65) PFDI-20, PFIQ-7, myometric parameters External ↑Urinary incontinence control ↑ Pelvic floor muscle strength Rodrigues (2019)28 Randomized clinical trial 18/17 58 (56-60) PFM function on examination Internal ↑ Pelvic floor muscle contraction strength Nilsen (2018)29 Prospective cohort 60 44 (36-54) ICIQ-SF, pad stress test Intravaginal ↓ Pad stress test Rodrigues (2018)27 Systematic review UDI-6, IIQ-7, FSDS-R, Oxford Scale, 1-h pad test External ↑Pelvic floor muscle strength ↓SUI de la Torre (2017)4 Prospective case series 48 46 (32-59) 1-h pad test, pelvic floor assessment (Oxford Scale), UDI-6, IIQ-7, FSFI, FSDS-R Intravaginal ↓ Sexual distress ↓ Pad stress test ↓ SUI ↑ Pelvic floor muscle strength Ong (2015)32 Randomized clinical trial 40 50-53 APFQ, pelvic floor assessment (Likert-type scale) Internal ↓ SUI ↑ Pelvic floor muscle strength Sønksen (2007)31 Prospective pilot study 33 19-44 No. of incontinence episodes, pads External ↑Urinary incontinence control Zolnoun (2008)33 Survey 49 30 (19-68) Survey External VVT is acceptable treatment ↓ Pain ↑ Enjoyment Abbreviations: APFQ, Australian Pelvic Floor Questionnaire; FIEI, Female Interventional Efficacy Index; FSDS, Female Sexual Distress Scale; FSDS-R, Female Sexual Distress Scale–Revised; FSFI, Female Sexual Function Index; ICIQ-SF, Incontinence Questionnaire–Short Form; IIQ-7, Incontinence Impact Questionnaire–Short Form; PFDI–20, Pelvic Floor Disability Index–20; PFIQ-7, Pelvic Floor Impact Questionnaire–7; PFM, pelvic floor muscle; QST, quantitative sensory testing; SUI, stress urinary incontinence; UDI-6, Urinary Distress Inventory–Short Form; VPA, vaginal pulse amplitude; VVT, vulvar vibration therapy. a Blank cells indicate not applicable/available. b Values formatted with a slash (2056/53 and 18/17) indicate . Open in new tab Table 2 Risk of bias.a Bias . Rullo (2018)10 . Guess (2017)19 . Marcus (2011)20 . Herbenick (2011)22 . Herbenick (2010)35 . Struck (2008)23 . Sipski (2005)21 . Davis (1996)9 . Thomas (2021)2 . Barassi (2019)30 . Rodrigues (2019)28 . Nilsen (2018)29 . Rodrigues (2018)27 . de la Torre (2017)4 . Ong (2015)32 . Sønksen (2007)31 . Zolnoun (2008)33 . Random sequence generation + − − ? ? + − − ? + − ? ? + − + + Allocation concealment ? − + ? − + ? − + ? − ? − + + ? ? Selective reporting ? − − ? ? ? − − ? ? − ? − − − ? ? Blinding (participants and personnel) + + + ? ? + ? − ? ? − + ? + + + + Blinding (outcome assessment) + + + ? ? + + − − + − + ? + ? + + Incomplete outcome data ? − ? − − ? − − ? − − − ? − − + + Bias . Rullo (2018)10 . Guess (2017)19 . Marcus (2011)20 . Herbenick (2011)22 . Herbenick (2010)35 . Struck (2008)23 . Sipski (2005)21 . Davis (1996)9 . Thomas (2021)2 . Barassi (2019)30 . Rodrigues (2019)28 . Nilsen (2018)29 . Rodrigues (2018)27 . de la Torre (2017)4 . Ong (2015)32 . Sønksen (2007)31 . Zolnoun (2008)33 . Random sequence generation + − − ? ? + − − ? + − ? ? + − + + Allocation concealment ? − + ? − + ? − + ? − ? − + + ? ? Selective reporting ? − − ? ? ? − − ? ? − ? − − − ? ? Blinding (participants and personnel) + + + ? ? + ? − ? ? − + ? + + + + Blinding (outcome assessment) + + + ? ? + + − − + − + ? + ? + + Incomplete outcome data ? − ? − − ? − − ? − − − ? − − + + + a High risk of bias. – Low risk of bias. ? Unclear risk of bias. Open in new tab Table 2 Risk of bias.a Bias . Rullo (2018)10 . Guess (2017)19 . Marcus (2011)20 . Herbenick (2011)22 . Herbenick (2010)35 . Struck (2008)23 . Sipski (2005)21 . Davis (1996)9 . Thomas (2021)2 . Barassi (2019)30 . Rodrigues (2019)28 . Nilsen (2018)29 . Rodrigues (2018)27 . de la Torre (2017)4 . Ong (2015)32 . Sønksen (2007)31 . Zolnoun (2008)33 . Random sequence generation + − − ? ? + − − ? + − ? ? + − + + Allocation concealment ? − + ? − + ? − + ? − ? − + + ? ? Selective reporting ? − − ? ? ? − − ? ? − ? − − − ? ? Blinding (participants and personnel) + + + ? ? + ? − ? ? − + ? + + + + Blinding (outcome assessment) + + + ? ? + + − − + − + ? + ? + + Incomplete outcome data ? − ? − − ? − − ? − − − ? − − + + Bias . Rullo (2018)10 . Guess (2017)19 . Marcus (2011)20 . Herbenick (2011)22 . Herbenick (2010)35 . Struck (2008)23 . Sipski (2005)21 . Davis (1996)9 . Thomas (2021)2 . Barassi (2019)30 . Rodrigues (2019)28 . Nilsen (2018)29 . Rodrigues (2018)27 . de la Torre (2017)4 . Ong (2015)32 . Sønksen (2007)31 . Zolnoun (2008)33 . Random sequence generation + − − ? ? + − − ? + − ? ? + − + + Allocation concealment ? − + ? − + ? − + ? − ? − + + ? ? Selective reporting ? − − ? ? ? − − ? ? − ? − − − ? ? Blinding (participants and personnel) + + + ? ? + ? − ? ? − + ? + + + + Blinding (outcome assessment) + + + ? ? + + − − + − + ? + ? + + Incomplete outcome data ? − ? − − ? − − ? − − − ? − − + + + a High risk of bias. – Low risk of bias. ? Unclear risk of bias. Open in new tab Sexual function The identified studies were based on numerous designs: review, single-arm prospective trial, population-based cross-sectional survey, prospective case-control, and retrospective analysis and indicate participants per group. Vibrator use In 1 survey, 53% of 3800 women had used a vibrator in their lifetime. The majority of women surveyed who used a vibrator (83.8%, n = 888) applied it to stimulate the clitoris, and 64% (n = 679) had used a vibrator inside the vagina.8 In a survey assessing positioning and application of pelvic vibrator use, 77% of women reported using a vibrator when lying down, and 58% applied a vibrator externally to the clitoris, with 23% doing circular movements and 36% performing up/down, back/forth movements.9 Functional characteristics of commercial vibrators When reviewing the functional characteristics of commercial vibrators, Rullo et al noted that vibrators vary by speed, type, and intensity of vibration. Intensity can be an important parameter to consider among aging women and women with urinary incontinence, multiple sclerosis, and/or sexual dysfunction.10,11 These groups of women might require higher-intensity vibration to achieve arousal and orgasm.12-16 Vibration and vasodilation Vibration facilitates vasodilation and blood flow in the pelvic floor muscles10 and was found to promote muscle group stretching and shortening and increase metabolic rate in skeletal muscles.17 These processes can result in improved tissue perfusion, which as a result aids in decreasing muscle tone and increasing relaxation.18 Intermittent vibration in early stages of arousal increases blood flow more consistently than continued vibration due to an alteration between sympathetic activity and parasympathetic recovery.10,18 Arousal Guess et al demonstrated improvement in the arousal and orgasm domains as well as genital sensation among women aged 19 to 64 years treated with a genital vibratory stimulation device called the Eroscillator (Advance Research Corporation).19 The study found significant interaction between sexual function and clitoral and right labial vibratory thresholds. Women with lower baseline vibratory thresholds (more sensitive) demonstrated significantly better improvement in the arousal domain at 1 month but no continuous improvement between 1 and 3 months. Yet, women with a higher baseline vibratory threshold (diminished sensation) had significant improvement in arousal at 1 month that continued to improve up to 3 months.19 Overall 82.5% (n = 33) of women noticed increased pleasant genital sensation during intercourse. In addition, 67.5% (n = 27) of participants noted improvement in physiologic vaginal lubrication.19 Orgasm The use of vibrators decreases the time to achieve orgasm and facilitates multiple orgasms.9,20 Continuous vibration as compared with intermittent vibration will more likely lead to an orgasm in the later stages of arousal due to persistent sympathetic activity.10 Furthermore, vibratory stimulation demonstrated a significant increase in the orgasm subscale of the Female Sexual Function Index (FSFI) for the period of active treatment.21,22 That said, Sipski et al21 were not able to show a significant difference between vibratory and manual clitoral stimulation when comparing their effects between women with spinal cord injury and healthy controls. Struck and Ventegodt cited the use of a vibrator as part of a holistic approach to treat anorgasmia. Among 500 women who had anorgasmia for an average of 12 years, 93% (n = 465) were able to experience an orgasm.23 Vibratory stimulation is positively correlated with increased sexual desire, satisfaction, and overall sexual function.10,24,26 Women who used a vibrator on a regular basis noted decreased sexual distress, improved FSFI scores (arousal, orgasm, and total; P < .001), and enhanced genital sensation.23 Positive beliefs about vibrator usage were also associated with the higher FSFI scores in all domains.22 Pelvic floor function Among the reviewed studies on the effect of vibrators on pelvic floor function, 2 main themes were identified: urinary incontinence, predominantly stress urinary incontinence (SUI), and pelvic floor muscle strength.27 Pelvic floor muscle strength In a randomized clinical trial among women who were unable to contract their pelvic floor muscles voluntarily, intravaginal vibratory stimulation was shown to be superior to intravaginal electrical stimulation in improving pelvic floor muscle strength (P = .026).28 Electric probe devices had a higher number of negative reviews (25.7%, 63/245) on Amazon.com among consumers of pelvic floor muscle training devices. Vibrating Kegel balls were noted to help with consumers’ urinary incontinence (12%, 140/1168) and had the highest number of reviews and ratings as compared with electric probes and pelvic floor/thigh exercisers.2 Urinary incontinence Vibrator use as part of the treatment of SUI showed decreased urinary leakage and was associated with improvement in incontinence symptoms.28 Nilsen et al discovered that by adding vibration during pelvic floor muscle training, the urinary leakage was reduced by 77% and 92% at 4 and 6 weeks of the intervention, respectively. They also noted that training for 6 weeks vs 4 weeks resulted in significantly higher improvement in the amount of stress-related leakage of urine (P < .003).29 Similarly, Barassi et al used a combination of vibration and manual therapy as an intervention to improve urinary incontinence.30 In that study, vibration was applied at the level of the abdomen, perineal area, lumbar area, and gluteal muscles. Neuromuscular manual therapy was applied to the diaphragm, iliopsoas, piriformis muscles, and sacrotuberous and sacrosciatic ligaments. Myometric measurements, such as muscle elasticity/plasticity, tone, and resistance, and validated questionnaires, including the PFDI-20 (Pelvic Floor Disability Index–20) and PFIQ-7 (Pelvic Floor Impact Questionnaire–7), were completed at baseline and after an intervention that included 8 sessions over 4-week period. All myometric parameters were significantly improved, and there was a significant reduction in questionnaire scores of 43% and 56% for the PFDI-20 and PFIQ-7, respectively.30 Unfortunately, it is unknown how much of the success in the aforementioned studies should be attributed to the vibration alone vs regular pelvic floor muscle training and manual therapy. Sønksen et al used the point of peak urethral resistance as a measurement to assess external sphincter pressure and pelvic floor muscle contraction.31 Vibration was applied to the perineum or clitoris of participants to identify the optimal location for vibrator placement to induce the strongest pelvic floor muscle contraction. The knowledge gained in healthy volunteers was applied to the women with SUI. After 6 weeks of once-weekly intervention, the first results were assessed, and women continued the intervention for another 3 months but without application of the vibrator. This resulted in a statistically significant change (P < .001), with 73% (24/33) being cured and 88% (29/33) being cured or improved.31 De la Torre et al evaluated the treatment of urinary incontinence with multimodal vaginal toning, including vibration, as used by women every other day for 45 days without performing voluntary pelvic muscle contractions.4 In the study, 82% of subjects had moderate to severe SUI at baseline, and by the end of the treatment period, only 18% were still incontinent, representing a clinically meaningful improvement in symptoms. Results were based on validated questionnaires—the UDI-6 (Urogenital Distress Inventory–Short Form; P < .001) and IIQ-7 (Incontinence Impact Questionnaire–Short Form; P < .001)—and the 1-hour pad test (P < .001). In addition to vibration, the device used in the study provides low-level light therapy in the red and near-infrared wavelength spectrum (662-855 nm) as well as heat (∼41 °C). Similarly to the other studies, it is unclear how much of the reported outcomes should be attributed to vibration itself vs light therapy and heat.4 In contrast Ong et al conducted a randomized controlled pilot study where women with SUI were assigned to 2 arms.32 One arm was instructed to perform pelvic floor muscle exercise daily, while the other was instructed to perform pelvic floor muscle exercise with the addition of an intravaginal vibrating device. At 4 weeks, the group utilizing the vibrating Kegel device had significantly improved scores on SUI (P = .017) and pelvic muscle strength (P = .027), although at 16 weeks only pelvic floor muscle strength remained significantly different between the groups (P = .003).32 Based on these results, vibration with biofeedback appears to be a promising tool to accelerate the effect of pelvic floor muscle contractions. Consistency of performing the exercise might be the most powerful factor. Vulvodynia (chronic vulvar pain) Vulvar vibration therapy (VVT) is based on the antinociceptive properties of vibration. This therapy was described in the study by Zolnoun et al.33 Forty-nine women with vulvodynia were recruited and instructed to apply an Evibra massager on their vulvas for 5 to 10 minutes a day. They were additionally advised to stretch the muscles of the introitus with gradual progression toward intravaginal insertion of the vibrator over the course of 4 to 6 weeks. Women were also recommended to use VVT before attempting vaginal intercourse. This study showed acceptability of VVT, with a positive effect on relieving genital pain. An overall 73% of women noted pain improvement, 74% cited increased sexual enjoyment, and 83% reported satisfaction with treatment. The majority of women (90%) were comfortable with their doctors offering the vibrator treatment.33 Discussion The aim of this systematic review was to survey the existing literature on the benefits of vibrators on pelvic health and sexual function. Although the level of evidence is currently weak—consisting of reviews, surveys, case-control studies, prospective cohorts, and only 2 randomized clinical studies—overall our review reinforced the positive effect of vibrator use across multiple clinical domains. Among the studies identified, vibrators were considered an accepted modality to enhance a woman’s sexual experience.34 Most women held predominantly positive beliefs about women’s vibrator use. Positive attitudes toward vibrators were associated with higher FSFI scores related to arousal, lubrication, orgasm, satisfaction, and decreased pain.20,22,35 Partner knowledge and acceptance of vibrator use were associated with higher sexual satisfaction for heterosexual women (P < .01).35 Each stage of the sexual response cycle can benefit from vibratory stimulation. By stimulating the mechanoreceptors in genital skin, vibrators can generate powerful sexual excitement in the somatosensory system that amplifies desire and arousal.36 By enhancing vaginal and clitoral blood flow, vibration improves circulation, potentiates engorgement of tissues, and facilitates lubrication via increased perfusion and third spacing of a transudative lubricant within the vagina, a key process of female sexual arousal.37 Between 11% and 60% of adult women report being unable to experience orgasm.23 Furthermore, 93% of women with anorgasmia are able to achieve orgasm with treatment involving the use of a vibrator, and it has been demonstrated that masturbation with a vibrator positively affects the number of orgasms that women experience during partnered sex.23-25 Vibrator use can also improve desire by creating positive feedback and reinforcement. It is known that among young healthy women, clitoral and vaginal sensitivity to vibration is increased during arousal.16 Few data exist on how aging affects genital sensitivity thresholds during sexual arousal. Without conflicting evidence, it is possible that aging women may benefit from using vibration during sexual arousal and that clitoral vibration may continue to provide benefits even if vaginal sensitivity has declined.10 Vibrator use also has indications for the management and prevention of urinary incontinence, as reflected in the cohort of studies evaluated. An estimated 30% to 50% of women do not know how to actively contract the pelvic floor muscles, and many are largely unaware of the role that the pelvic floor plays in the body.28 Pelvic floor strength and control are key factors in preserving urinary continence. By promoting improved pelvic circulation and pelvic floor muscle health, the functions and integrity of the supported organs, such as the bladder and urethral sphincters, can also improve. It has been well demonstrated that pelvic floor muscle training, biofeedback, and electrostimulation techniques can activate pelvic floor muscles and serve as physiotherapy as support for surgical treatment or as independent therapy.38 While significant urinary leakage secondary to injury or childbirth often requires surgery, vibrators have potential to serve as a health maintenance tool to help with mild cases of incontinence and/or as a preventative measure after pregnancy, during postreproductive years, and in menopause. Vulvodynia, or chronic unexplained pain of the introitus/vestibule, is a serious condition that can be debilitating. The exact etiology is not known; however, it is believed to be multifactorial, including stress, past emotionally traumatic experiences, vaginal infections, and an increase in the density of nerve endings in the vestibule.39 Similar to VVT, commercially available vibrators can help women who have vulvodynia.33 The VVT effect is attributed to the antinociceptive and desensitization properties of vibration therapy.33 Another contributing factor may include vibration-induced arousal, which forms positive associations with one’s genitalia and creates pleasure that assists with modulating pain. With limited treatment modalities available for vulvodynia, vibration potentially helps to improve pain and make tampon insertion and/or vaginal penetration possible. Women who undergo cancer treatment with pelvic radiation frequently experience vaginal scarring and pain. Practitioners often recommend use of a vaginal dilator for these women, with some finding its use daunting and uncomfortable.40,41 Vibrators can improve circulation, relieve pain, and be helpful in addition to vaginal dilators. Gentle vulvar vibration, with gradual progression to insertion of the vibrator into the vagina, could benefit these women to keep the vagina patent. Vaginal dilators are typically prescribed for patients with vaginismus and genitopelvic pain penetration disorder. These patients may benefit from using a vibrator, which is reported to be more familiar and comfortable to patients.33,42 Vibrators are much less expensive than many pelvic floor treatment modalities and are readily accessible to patients who might not otherwise have access to formal treatments. Conclusion At this time, the benefits or drawbacks of local vibration for pelvic floor disorders have not been comprehensively studied. There are scarce literature and data on this topic despite commercial vibrators being widely available. Conditions that might benefit from vibrator use include pelvic floor dysfunction, incontinence, vulvodynia, and sexual dysfunction, which are commonly addressed by urologists, gynecologists, and urogynecologists. These providers need a more elaborate education on women’s sexual health and vibrators. Continued research surrounding medical uses of vibrators is warranted to better understand their role in sexual and pelvic health. Based on our findings, vibrator use has a positive effect in all domains of the sexual response cycle. Vibrators decrease the time to achieve orgasm, facilitate multiple orgasms, and improve sex-related distress. They also can improve urinary incontinence, pelvic floor muscle strength, as well as chronic unexplained vulvar pain. 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TI - Is it time for doctors to Rx vibrators? A systematic review of pelvic floor outcomes
JF - Sexual Medicine Reviews
DO - 10.1093/sxmrev/qeac008
DA - 2023-01-19
UR - https://www.deepdyve.com/lp/oxford-university-press/is-it-time-for-doctors-to-rx-vibrators-a-systematic-review-of-pelvic-Gao9waWrFc
SP - 15
EP - 22
VL - 11
IS - 1
DP - DeepDyve
ER -