Sexual Medicine最新文献

Introduction: Vasectomy is a widely used, safe, effective method of permanent contraception and contributes to healthy sexuality.

Aims: We have conducted a 3-step observational clinical study to develop a vasectomy regret risk score and guide patients and clinicians when discussing a vasectomy.

Methods: A 3-step approach has been followed. First, experts involved in male health have proposed risk factors for regret (remorse) after vasectomy, defined by a vasectomy reversal surgery or medically assisted reproduction. The selected factors were evaluated in 1200 patients vasectomized in the last 15 years. Finally, the expert panel has constructed a score for predicting regret after vasectomy.

Results: Fifty-two international experts identified 17 risk factors for vasectomy regret. Five of the risk factors were significant: an age <35 years old, a high Barrat Impulsivity Score, a low level of education, and a patient who didn't understand that the vasectomy might not be reversible or for whom the contraception responsibility is ideally feminine, or no responsible partner. On multivariate analysis, 3 risk factors and 2 "sine qua non" conditions were used to build the decision algorithm. A risk score ≥ 4 required information on sperm cryopreservation before vasectomy, and those with a risk score ≥ 7 required extra time for reflection. The scoring system was proposed to 52 international experts and accepted with 86.7% strongly agreeing. The model's sensitivity and specificity were 0.98 and 0.53, respectively.

Conclusion: A decisional algorithm was established to identify patients requiring information on sperm cryopreservation before vasectomy or additional time for reflection to reduce the risk of vasectomy regret. The algorithm contains 3 risk factors and 2 "sine qua non" conditions.

Background: Compulsive Sexual Behavior Disorder is a new category in the 11th version of the International Classification of Diseases and is showing neuropsychological similarities to substance dependencies and behavioral addictions.

Aims: This experimental study aims to further our knowledge on implicit associations in Compulsive Sexual Behavior (CSB) with a clinical sample.

Methods: Participants completed an Implicit Association Test modified with pornographic pictures. In addition, problematic sexual behavior and sensitivity toward sexual excitation were assessed.

Outcomes: We collected data on implicit associations from 47 heterosexual men with CSB (age, M = 36.51, SD = 11.47) and a control group of 38 men without the condition (age: M = 37.92, SD = 12.33).

Results: Results show significantly more positive relationships between implicit associations of pornographic pictures with positive emotions, as well as with problematic sexual behavior and sensitivity toward sexual excitation, in men with CSB vs. men without CSB. Furthermore, implicit associations, sexual excitation, and sexual inhibition due to threat of performance consequences differentiated significantly between groups using a binary stepwise logistic regression analysis. The findings are in line with those of previous subclinical investigations and support the assumption of pronounced positive implicit associations in CSB. Moreover, as suggested by the I-PACE model of addictive behaviors, implicit associations may be crucial to the maintenance of behavioral addictions.

Clinical implications: Implicit associations could be addressed in therapy to illustrate cognitive processes of those affected and as an outcome measure in research on treatment efficiency.

Strengths & limitations: The present study is the first to investigate implicit associations in CSB in a clinical sample. Findings are limited to heterosexual men.

Conclusion: Findings can be seen in accordance with a proposed classification of CSB as a behavioral addiction.

Background: Spinal cord injury/disease (SCI/D) profoundly affects both sexuality and urinary function. Catheterization is often necessary to manage bladder voiding and it can interfere with sexual activity.

Aim: We aim to investigate the effect of the bladder evacuation method on sexual activity in women with chronic SCI/D.

Methods: This cross-sectional study at a specialized SCI/D rehabilitation center recruited women ≥18 years with chronic SCI/D using intermittent or suprapubic catheterization. We assessed sexual activity and sexual function with the German version of the Sexual Behaviour Questionnaire and the Female Sexual Function Index (FSFI) and a study-specific questionnaire.

Outcomes: The primary outcome was sexual activity and secondary outcomes included factors influencing sexual activity, such as age and SCI/D characteristics.

Results: Around half of the evaluated women were sexually active, regardless of bladder evacuation method. However, significantly (P = .018) more women using intermittent catheterization (IC) (66.7%, 20/30) were sexually active compared to those with a suprapubic catheter (SPC) (29.4%, 5/17). The main concern for women using IC was urinary incontinence during sex (43.3%, 13/30), while those with a SPC struggled with self-image due to the catheter (58.8%, 10/17). Not having a partner was the most common reason for sexual inactivity in both groups (59.1%). The median FSFI total score was significantly (P = .049) greater in the IC group (median 26.4, lower quartiles [LQ] 8.9/upper quartiles [UQ] 28.8) compared to the SPC group (median 11.5, LQ 5.4/UQ 25.5), which represents a lower grade of sexual dysfunction in women using IC.

Clinical translation: Sexual education is crucial and should be adapted to the different types of bladder management.

Strength & limitations: This study shows first data on the effect of catheter on sexual activity in women. Limitation of our study is the small sample size and response bias by the high rejection rate of women with SPC.

Conclusions: Few women with SPC remain sexually active after SCI/D, while the majority of women using IC do, highlighting issues around self-image and urinary incontinence.

Background: In Asian countries, discussing sex-related issues remains a taboo. Sexual dysfunction is not even considered a serious disorder in Pakistan.

Aim: To explore sexual dysfunction and marital satisfaction within the Pakistani context to develop supportive intervention programs.

Methods: This study entailed a mixed method approach and was carried out in Karachi, Pakistan. The sample comprised 28 married men, and data were gathered by in-depth interviews. Subsequently, data were analyzed through content analysis.

Outcomes: There is a strong relationship between marital dissatisfaction and sexual dysfunction in adult married males aged 25 to 40 years in Pakistan.

Results: The analysis of participants' perspectives revealed 5 themes: psychosocial issues, rationale of openness in marital life, insufficient sexual knowledge, lack of sexual health service, and individual consequences.

Clinical implications: The results of this study suggest that it is an important suggestion to the government of Pakistan to introduce sexual health counseling and premarital counseling programs at the university level. The Ministry of Health and Higher Education needs to promote awareness about sexual health, sexual dysfunctions, and marital satisfaction, which will enable men to understand their sexual problems and effectively cope with them.

Strengths and limitations: The results of this study highlight the biopsychosocial dimensions of human sexuality. In this context, the psychosocial aspects associated with sexual dysfunctions are influenced by cultural and societal norms, where open discussions about sexual issues between male and female partners may be limited due to concerns about maintaining harmony in marital relationships. The limitation of this study is that the sample is not generalized; it is also not a demographic representation of all socioeconomic groups in Pakistan. Participants in low and middle classes reported an inability to seek help from professionals due to the high costs of treatments. Therefore, the results cannot to be extended to all Pakistani males.

Conclusion: In this study, male sexual dysfunction strongly affects marital satisfaction within the couple. As such, marital counseling and psychotherapeutic strategies play an important role to help individuals and couples manage their sexual dysfunctions and enhance their marital satisfaction.

Background: Peyronie's disease (PD) is a fibrotic disorder affecting the penile tunica albugínea, with unclear pathophysiology despite centuries of recognition.

Aim: This scoping review maps the effects of interventions in basic PD research, synthesizing evidence from in vivo and in vitro studies to guide future investigation.

Methods: In October-November 2023, a systematic search was conducted across PubMed, Embase (Ovid), Science of Web, and Scopus, following SRYCLE's guidelines. Relevant studies were screened for data on interventions targeting PD in vivo and in vitro, with no language or time restrictions.

Outcomes: Primary outcomes included changes in extracellular matrix (ECM) proteins, myofibroblast activity, and plaque size.

Results: Of 683 articles screened, 40 studies were included. Key interventions such as phosphodiesterase inhibitors and stem cell therapies reduced ECM proteins and myofibroblast activity, particularly in early-stage PD models. However, none of the studies adhered to the ARRIVE guidelines, highlighting a gap in reporting standards.

Clinical translation: Findings suggest potential benefits of early and multimodal treatment strategies, but further human trials are needed to bridge the gap in clinical practice.

Strengths and limitations: This review systematically synthesizes animal and cellular research on PD, highlighting significant preclinical findings. However, the lack of standardized reporting and limited human studies restricts direct clinical applicability.

Conclusion: Further research should prioritize adherence to reporting standards, optimize treatment timing, and explore combination therapies to advance PD management.

Background: While premature ejaculation (PE) can be divided into lifelong PE (LPE), acquired PE, natural variable PE (NPE), and subjective PE (SPE), there is no objective method to classify PE.

Aim: To determine the value of serum serotonin (5-HT), leptin, and norepinephrine (NE) levels in the classification of PE.

Methods: From July 2023 to July 2024, we recruited 150 participants and divided them into 4 groups: LPE (43 cases), NPE (32 cases), SPE (35 cases), and non-PE (40 cases) groups. All participants' baseline data, premature ejaculation diagnostic tool score, and intravaginal ejaculation latency time were investigated. In addition, all participants' serum 5-HT, leptin, and NE levels were measured.

Outcome: Serum 5-HT, NE, and leptin levels were compared among all groups.

Results: Serum 5-HT levels were lower and NE and leptin levels were higher in the LPE group compared to the SPE, NPE, and non-PE groups (P < .05). However, serum 5-HT, leptin, and NE levels were not significantly different among the non-PE, NPE, and SPE groups (P < .05). In addition, serum 5-HT <95.0 ng/mL, NE >543.0 ng/L, and leptin >19.8 ng/mL may be predictive indicators of LPE.

Clinical significance: Based on serum 5-HT, NE, and leptin levels, LPE can be distinguished from SPE and NPE, which provides an objective basis for the treatment of PE.

Strengths and limitations: There is no effective method to classify PE. The main limitation of this study is the limited sample size.

Conclusion: The serum 5-HT, leptin, and NE levels in PE patients may contribute to the classification of PE.

Background: Both serum testosterone (T) levels and erectile dysfunction (ED) are associated with systemic diseases in men and ED is the most common presenting symptom of hypogonadism.

Aim: To evaluate the association of serum total testosterone (TT) levels with cardiometabolic diseases in men with ED.

Methods: Serum endogenous TT levels were determined to evaluate their associations with cardiometabolic diseases in men with ED in outpatient clinics. Participants were divided into hypogonadal with TT < 350 ng/dL (12.1 nmol/L) and eugonadal groups, as well as into four equal quartiles based on TT levels. The Framingham risk score was used to estimate individual 10-year coronary heart disease (CHD) risk.

Main outcome measures: Cardiometabolic factors included obesity, diabetes mellitus (DM), hypertension (HT), dyslipidemia, and the Framingham risk score.

Results: From 2010 to 2021, a total of 4467 subjects with ED were consecutively recruited for this study, and 3909 subjects' (87.5%) data with a mean age of 53.0 ± 12.9 (20.0-88.0) years had data eligible for analysis. Testosterone levels declined with age and a higher body mass index (BMI) was associated with lower T levels across all age groups (P < .001). Compared to the eugonadal group, the hypogonadal group was older and had a higher BMI and more cardiometabolic diseases (all P < .01). In multivariate analysis, odds ratio (OR) for hypogonadism was highest in men with obesity (2.51), followed by age group of ≥70 years (2.32), DM (1.59), HT (1.41), and dyslipidemia (1.26). Compared with the lowest TT quartile, higher quartiles of TT had significantly lower risk for cardiometabolic diseases (all P < .001). Among men over 50 yrs, hypogonadal men had a higher 10-year CHD risk than eugonadal men as predicted by the Framingham risk score (P < .001).

Clinical implications: Our results highlight the value of determining TT levels in men with ED because of their association with cardiometabolic diseases and the potential benefits of T therapy for improving men's health.

Strengths and limitations: Strengths of this study include a relatively large sample and detailed medical history collection. Limitations included a small portion of subjects with repeat TT tests, and the lack of data on free T and bioavailable T levels, and single-site recruitment.

Conclusions: TT levels are independently associated with cardiometabolic diseases including obesity, DM, HT, and dyslipidemia, and indicate a higher risk for CHD in men with ED. Measuring TT levels in men with ED presents an opportunity to improve overall health and reduce CV risk.

Background: Increasing evidence suggests that a diet rich in antioxidants may prevent erectile dysfunction (ED), but the impact of comprehensive dietary antioxidants on ED has been little studied.

Aim: To investigate the association between the composite dietary antioxidant index (CDAI) and ED risk in adult men.

Methods: The study performed a cross-sectional analysis using data from the 2001-2004 National Health and Nutrition Examination Survey to investigate the association between the composite dietary antioxidant index (CDAI) and ED. The connection between the CDAI and ED was assessed using univariate and multivariate weighted logistic regression models, as well as the restricted cubic spline.

Outcomes: Association between the CDAI and the prevalence of ED.

Results: The study included a total of 3699 participants, among whom 1042 were diagnosed with ED, resulting in a prevalence of 28.17%. Multivariate weighted logistic regression consistently showed a negative association between the CDAI and ED (OR = 0.95, 95% CI: 0.92-0.98, P = .005). The group with the highest CDAI (Q4) had a 33% reduced risk of ED than the group with the lowest CDAI (Q1) when the CDAI was regarded as a categorical variable (OR = 0.67, 95% CI: 0.49-0.91, P = .014). Restricted cubic spline analysis showed that the CDAI was linearly related to the risk of ED (non-linearity P = .652). Furthermore, subgroup analysis indicated that the inverse relationship between CDAI and ED was more pronounced in individuals under 60 years of age, those with diabetes, and those without hypertension.

Clinical implications: Dietary strategies to increase antioxidant intake might offer a potential approach to reducing ED risk and supporting men's sexual health.

Strengths and limitations: This is a large-scale study investigating the association between the CDAI and ED. However, as a cross-sectional study, the timeliness of the dataset and the recall bias inherent in dietary data somewhat limit the reliability of the results.

Conclusion: This study identified a significant inverse association between the CDAI and ED risk among adult men in the United States; however, as a cross-sectional study, this research cannot establish causation, and further longitudinal studies are needed to validate these findings and provide more definitive evidence.