Sexual dysfunction (SD) is a prevalent and multifactorial condition that affects individuals of both sexes, encompassing disorders such as erectile dysfunction, hypoactive sexual desire disorder, orgasmic disorders, and pain-associated dysfunctions. The pathophysiology of SD is complex, involving intricate interactions between neurological, psychological, vascular, and endocrine systems. Neurological disorders, including multiple sclerosis, Parkinson’s disease, and spinal cord injury, can significantly impair sexual function by disrupting the neural circuits that regulate sexual behavior. Neuromodulation, a therapeutic approach that modulates neural activity through electrical or chemical stimulation, has emerged as a promising treatment for SD. 
Objective: The review aimed to evaluate the physiological mechanisms underlying neuromodulation, the clinical efficacy of different neuromodulation techniques (including spinal cord stimulation, sacral neuromodulation, and percutaneous tibial nerve stimulation), and the outcomes observed in treating SD. Additionally, it explored challenges and future directions for research in optimizing neuromodulation as a treatment strategy for sexual dysfunction.

Comprehensive research on the Impact of Neuromodulation on Sexual Dysfunction. databases PubMed, EMBASE, Web of Science, and the Cochrane Library engines were the main databases used for the search process, and articles were collected between 2024 - 2025. The terms used in the search were: Neuromodulation, Sacral Neuromodulation (SNM), Percutaneous Tibial Nerve Stimulation (PTNS), and Sexual Dysfunction (SD).

Neuromodulation shows promise in treating sexual dysfunction in patients with neurological disorders, as evidenced by recent studies. However, challenges remain in accessing these therapies and optimizing treatment strategies for diverse patient outcomes.
These findings underscore the clinical potential of neuromodulation in treating sexual dysfunction secondary to neurological disease, while also emphasizing the heterogeneity in patient outcomes.

Several neuromodulation approaches have been investigated for SD treatment:

•	Spinal Cord Stimulation (SCS)
Involves the implantation of electrodes within the spinal cord to control neural impulses.
Results: Studies have shown improvements in autonomic control, erectile function, and genital sensitivity, particularly for those with spinal cord injury.

•	Sacral Neuromodulation (SNM)
Utilizes electrical stimulation to stimulate sacral nerve roots to affect bladder, bowel, and sexual functions.
Findings: Effective in female sexual dysfunction (FSD) and erectile dysfunction.

•	Percutaneous Tibial Nerve Stimulation (PTNS)
A non-invasive method that stimulates the tibial nerve that has established connections with the autonomic pelvic nerves.
Results indicate an improved sexual function in patients diagnosed with multiple sclerosis and pelvic floor dysfunctions.

•	Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS)
Non-invasive techniques stimulate cortical areas involved with sexual function.
Findings: Potential effects on libido and sexual motivation, though evidence remains limited.

FURHTER MORE,
Neuromodulation affects its outcomes through numerous mechanisms:

•	Neuroplasticity Induction: Promotes neural rewiring and recovery in damaged circuits.
•	Autonomic Regulation: Balances sympathetic and parasympathetic activity to improve genital blood flow and arousal.
•	Neurotransmitter Modulation: Enhances dopamine, serotonin, and oxytocin signaling, influencing libido and mood.
•	Pain modulation is used to relieve pelvic pain, a common cause of sexual dysfunction.

Neuromodulation represents a promising frontier in SD treatment, with growing evidence supporting its efficacy. While techniques such as SCS, SNM, and PTNS show potential, further research is needed to refine protocols, improve patient selection, and enhance accessibility. Advances in neurotechnology may soon enable more targeted and effective neuromodulation therapies for individuals suffering from SD.