How Genital Nerve Stimulation - GNS procedure - Can Calm Your Heart and reduce your Blood Pressure: A Look into Parasympathetic Genital Neuromodulation

Prof. Prof. DK Prof. h.c. China Dr. med. Marc Possover

Chairman of the International Society of Neuropelveology – www.theison.org

Member of the French National Academy of Surgery

At NeuroGyn, our mission is to advance neuromodulation therapies that not only address primary symptoms but also enhance overall health and well-being. The PosStim® neurostimulator, originally developed for the treatment of idiopathic Overactive Bladder (iOAB), has demonstrated a unique therapeutic profile that extends far beyond bladder control. Through targeted low-frequency stimulation of the genital nerves – particularly in the richly innervated area anterior to the pubic bone—PosStim® activates both somatic sensory nerves and autonomic fibers, including the cavernous and pelvic splanchnic nerves (S2–S4). This neuromodulation triggers parasympathetic reflexes that not only calm bladder overactivity, but also lead to:

–        Reduction in blood pressure (antihypertensive effect)

–        Slowing of heart rate (anti-tachycardic effect)

–        Improvement of genital blood flow and sexual function

These effects reflect a systemic parasympathetic activation, offering multifaceted benefits particularly relevant to aging patients. Most individuals affected by iOAB are in age groups at increased risk for hypertension, tachycardia, and even myocardial infarction. The ability to simultaneously manage multiple autonomic dysfunctions with a single, minimally invasive therapy positions GNS with PosStim® as a paradigm shift in integrative pelvic neuromodulation. By targeting the autonomic nervous system, GNS offers a holistic treatment modality that addresses multiple comorbidities commonly seen in iOAB patients.

PosStim® is more than a bladder therapy – it’s a precision tool for restoring autonomic balance.

NeuroGyn’s pioneering work in this field confirms that genital nerve stimulation is not just about urology, but about whole-body autonomic regulation – with the potential to redefine standards in women’s health, cardiometabolic risk reduction, and sexual medicine.

When most people think of genital nerve stimulation, they think of sensation and function. But did you know that low-frequency stimulation of the genital autonomic nerves nerves can actually slow the heart rate and lower blood pressure? This phenomenon occurs through “parasympathetic reflexes” – the body’s built-in “braking system” for stress and overactivity. Stimulating the dorsal nerve of the penis or clitoris, or the cavernous nerves, sends signals to the brainstem that activate vagal pathways, slowing the heart and relaxing blood vessels.

Why Genital Nerve Stimulation (GNS) Targets More Than Just the Dorsal Nerves?

In male and female anatomy alike, the area just anterior to the pubic symphysis is among the richest concentrations of genital nerve endings—making it the ideal site for targeted, effective stimulation with minimal invasiveness.

When placing an electrode in front of the pubic bone – such as in the NeurGyn’s patented GNS procedure – it’s important to recognize that stimulation affects a wide range of critical nerve structures, not just the Dorsal Nerve of the Penis (DNP) or Clitoris (DNC).

Anatomically, this region is a dense neurovascular plexus where multiple nerve types converge:

  • Dorsal somatosensory nerves(DNP/DNC) – responsible for sensory input from the external genitalia
  • Cavernous nerves (CN)– parasympathetic fibers that play a central role in penile or clitoral erection by inducing vasodilation in the corpus cavernosum
  • Autonomic genital fibers– including sympathetic fibers that regulate detumescence and vascular tone, as well as pelvic plexus branches
  • Fine sensory afferentsfrom adjacent pelvic and perineal regions

Thus, by placing the GNS electrode in this strategic location, we are not only stimulating the dorsal sensory nerve but also engaging the entire genital autonomic neuroplexus – including the cavernous nerves and mixed autonomic fibers responsible for genital arousal, vascular regulation, and deep pelvic sensation.

This multi-nerve engagement is a distinct advantage of GNS, enabling therapeutic effects beyond pure sensory modulation, including:

  • Autonomic regulation
  • Erectile or engorgement support
  • Reflexive neuromodulation of lower urinary tract or pelvic organs

Physiological Effects of Genital Nerve Stimulation on Heart Rate and Blood Pressure

1 Heart Rate – Bradycardia (slowed heart rate)

Activation of parasympathetic pathways – particularly through afferent fibers of the pudendal nerve and its branches, including the dorsal nerve of the penis or clitoris – can induce significant cardiovascular effects. These sensory inputs can trigger reflex mechanisms such as the bulbocavernosus reflex or the genito-cardiac reflex, which project centrally to the nucleus tractus solitarius in the brainstem. This central integration leads to the activation of vagal efferent pathways, resulting in cardioinhibitory responses such as bradycardia. These physiological effects closely resemble those seen with direct vagal stimulation, underlining the potential of genital nerve afferents to modulate autonomic cardiovascular control.

References:

  1. Bennett, M.R. (2000). Autonomic neuromodulation: pharmacological and physiological basis.Clin Exp Pharmacol Physiol.
  2. Krassioukov, A. et al. (2009). Autonomic dysreflexia in spinal cord injury: clinical presentation and evaluation. J Spinal Cord Med.
  3. Amann, M. et al. (2011). Neural mechanisms of cardiovascular control during exercise. J Physiol.

2 Blood Pressure – Hypotension (blood pressure reduction) 

Vasodilation in the pelvic and genital vasculature is primarily mediated by parasympathetic activation, particularly via the cavernous nerves, which originate from the pelvic splanchnic nerves (S2–S4). When afferent pathways are sufficiently stimulated, this local response can evolve into a systemic effect, characterized by a reflex-mediated inhibition of sympathetic tone, ultimately leading to a reduction in blood pressure. However, in certain cases – especially with high-frequency or noxious stimulation—the initial response may involve a transient activation of the sympathetic nervous system, resulting in a temporary increase in heart rate and blood pressure before parasympathetic mechanisms predominate.

References:

  1. Andersson, K.E., Wagner, G. (1995). Physiology of genital sexual arousal: the basis of a new classification of female sexual dysfunctions. J Sex Marital Ther.
  2. Yuan, B.X. et al. (1993). Pelvic nerve stimulation-induced increase in genital blood flow and its autonomic mechanisms. Am J Physiol.
  3. Lang, R.E. et al. (1980). Cardioinhibitory reflexes originating from the genital tract. Pflügers Archiv.

3 Specific Observations in Low-Frequency Stimulation

Animal studies, particularly in cats, dogs, and rats, have demonstrated that low-frequency stimulation (typically in the range of 5–10 Hz) of the cavernous nerves or dorsal penile nerves produces a series of distinct autonomic responses. These include vasodilation within the genital vasculature, leading to a marked increase in local blood flow. When parasympathetic activation is sufficiently strong, this localized effect can extend systemically, resulting in a reduction of arterial blood pressure. In addition, such stimulation has been shown to induce bradycardia, mediated reflexively via the vagus nerve, reflecting a coordinated parasympathetic cardiovascular response.

References:

  1. Gerstenberg, T.C. et al. (1987). Neural control of penile erection: evidence for a role of the pelvic ganglia. Am J Physiol.
  2. Marson, L., McKenna, K.E. (1994). CNS integration of erection and ejaculation. In: Bancroft J, ed. The Pharmacology of Sexual Function and Dysfunction.

 4 Clinical Relevance

In neuromodulation therapies such as Genital Nerve Stimulation (GNS), these effects are purposefully harnessed:

  • Low-frequency stimulation may be used therapeutically to lower blood pressure, particularly in patients with autonomic dysregulation or hypertension.
  • Conversely, bradycardia may be an undesired side effect in cases of overstimulation.

Prevalence of Hypertension in iOAB Patients

A cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) found that among participants aged approximately 74 years, 38.9% of women and 31.6% of men reported OAB symptoms. Notably, among those on antihypertensive medications, men with OAB had higher systolic blood pressure and lower odds of achieving blood pressure control compared to those without OAB.

Reference: 

Yuan, J., et al. Association of Overactive Bladder With Hypertension and Blood Pressure Control: The Multi-Ethnic Study of Atherosclerosis (MESA). Urology. 2021 Jul;153:66–72.
DOI: 10.1016/j.urology.2021.04.033

Another study indicated that hypertension is significantly associated with OAB, with patients having hypertension exhibiting a higher incidence of OAB than those without hypertension. Research focusing on women in İzmir, Turkey, reported that 42.8% of adult women experienced OAB symptoms, and hypertension was significantly associated with these symptoms.

Reference:

Ozdemir, F., et al. Prevalence and Possible Risk Factors of Overactive Bladder Symptoms in Women Living in the City of Izmir. Journal of Urological Surgery. 2021;8(4):262–268. DOI: 10.4274/jus.galenos.2021.2021.0001


Conclusion

These findings suggest that a substantial proportion of patients with iOAB also suffer from hypertension. This comorbidity is particularly relevant for older adults, who are more susceptible to both conditions. The presence of hypertension in OAB patients may complicate management and indicates a need for integrated treatment approaches. At NeuroGyn, we recognize the interplay between urinary and cardiovascular health. Our Genital Nerve Stimulation (GNS) therapy, delivered via the PosStim® neurostimulator, is designed to address iOAB symptoms. Importantly, GNS has demonstrated potential benefits beyond bladder control, including:

  1. Reduction in blood pressure through parasympathetic activation
  2. Modulation of heart rate, potentially addressing tachycardia
  3. Improvement in sexual function via enhanced genital blood flow

By targeting the autonomic nervous system, GNS offers a holistic treatment modality that addresses multiple comorbidities commonly seen in iOAB patients.

Reference:

Rosas, S. E., & Pickering, T. G. The Relationship Between Overactive Bladder and Cardiovascular Disease: More Than a Shared Risk Factor. Frontiers in Cardiovascular Medicine. 2021;8:695106.
DOI: 10.3389/fcvm.2021.695106

At NeuroGyn, we continue to lead research into how pelvic nerves affect the entire body – and how they can be stimulated with precision to relieve suffering and enhance quality of life. Pelvic nerves are not just local messengers. They speak to the heart, the brain, and beyond.

 

Explore more about pelvic neuromodulation and our pioneering GNS technique at www.neurogyn.com

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