Sexual Medicine最新文献

Background: Female genital cosmetic surgery (FGCS), particularly labiaplasty, has gained increasing visibility and demand in clinical practice.

Aim: To examine the perceptions of gynecology physicians and residents regarding ethical aspects and knowledge related to FGCS, with a focus on labiaplasty.

Methods: A cross-sectional study was conducted with 404 physicians, including 327 (80.9%) women and 77 (19.1%) men. Participants completed a structured questionnaire assessing their ethical perspectives on vulvovaginal cosmetic procedures and their specific knowledge of interventions such as labiaplasty, hymenoplasty, clitoroplasty, and others.

Outcomes: Differences in ethical views and knowledge levels between experienced physicians and residents were evaluated.

Results: The findings revealed no significant differences between physicians and residents in ethical perceptions of labiaplasty. However, more experienced physicians reported greater exposure to patients seeking these procedures and demonstrated higher levels of knowledge regarding specific techniques.

Clinical implications: Despite greater clinical exposure, ethical perspectives seem to be shaped early during academic training, underscoring the importance of formal education on FGCS.

Strengths and limitations: This study provides insights into a relatively underexplored topic in medical education. However, the use of self-reported measures and a cross-sectional design may limit causal interpretations.

Conclusion: Ethical perceptions of FGCS are consistent across levels of clinical experience, suggesting a strong influence of medical training and reinforcing the need for structured discussions on the topic in educational curricula.

Background: The development of recurrent ischemic priapism (RIP) is associated with mental health disorders, psychiatric medications, and substance use, but the temporal relationship between the onset of RIP and the development of these risk factors is poorly understood.

Aim: This study aimed to investigate the chronology of psychosocial and substance use risk factors relative to the initial clinical presentation of RIP.

Methods: We conducted a retrospective cohort study of 73 adult patients diagnosed with RIP at a single academic center, identified via manual chart review of the electronic health record. Patients presenting with RIP between 2004 and 2020 were included, with data collection extending to 2025 to ensure a minimum follow-up of nearly 5 years for all participants to minimize censoring bias and capture delayed risk factor onset.

Outcomes: The date of the first RIP presentation (index event) was compared to the first documented date of several risk factors, including anxiety, depression, psychiatric medication use, and substance use.

Results: In the overall cohort, there was no statistically significant difference in the proportion of any risk factor developing before versus after the onset of RIP. Further, in a sub-analysis of 35 patients with sickle cell disease (SCD), a higher proportion of patients initiated psychiatric medication after the onset of RIP, although this was not statistically significant (P = .0522). No other factors reached statistical significance in the SCD sub-analysis.

Clinical implications: The findings suggest that RIP may be a psychologically traumatic event that contributes to the development of the same psychosocial risk factors it is associated with.

Strengths and limitations: The primary strength of this study is its novel investigation into the temporal relationship between RIP and psychosocial risk factors, supported by a design that ensured a minimum follow-up period of over 4 years for all participants. Limitations are primarily related to its retrospective, single-center chart-review design.

Conclusion: Our findings suggest a complex, potentially bidirectional relationship that highlights the need for integrated mental health screening for all patients with RIP, particularly for the high-risk SCD population.

Background: Multiple sclerosis (MS), a neurodegenerative disease, frequently causes sexual dysfunction (SD) besides the well-known motor impairment, which significantly reduces patients' quality of life (QOL).

Aim: This meta-analysis evaluates the effectiveness of non-pharmacological interventions for MS-related SD.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of PubMed, ScienceDirect, CINAHL, and Cochrane databases identified randomized and clinical trials; data were extracted, the risk of bias was assessed, and meta-analyses were conducted.

Outcomes: The primary outcomes were changes in sexual function, satisfaction, and QOL.

Results: A total of 34 studies were included and eligible for meta-analysis. Pooled analyses revealed that yoga did not significantly improve sexual function standardized mean difference (SMD = -0.18, P = .84). However, structured exercise protocols (treadmill, aerobic, and aquatic exercises) showed significant improvements in sexual function (SMD = 2.88, P = .04), with aquatic exercise being particularly effective (SMD = 14.76, P = .0001). Mindfulness interventions also enhanced sexual function (SMD = 4.40, P < .0001). While psychoeducational programs did not significantly improve overall sexual QOL (SMD = 16.40, P = .18), they significantly improved sexual function (SMD = 3.46, P = .004) and satisfaction (SMD = 7.73, P = .028).

Clinical implication: Tailored exercise and psychoeducational interventions can be recommended to improve sexual function and satisfaction in patients with MS.

Strengths and limitations: Strengths include adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and comprehensive analysis; limitations are the heterogeneity of interventions and the short-term nature of the included studies.

Conclusion: Tailored exercise and psychoeducation significantly benefit sexual function in MS, while other therapies like yoga require refinement; future research should investigate long-term outcomes and patient-specific factors.

Background: While there are data showing the effects of gender-affirming hormone therapy on sexual satisfaction in transgender and gender-diverse individuals, there is no research on sexual function in patients seeking or undergoing gender-affirming hysterectomy (GAH).

Aim: This project is a descriptive study of baseline characteristics (pre-hysterectomy) in patients seeking GAH.

Methods: Twenty participants at a single tertiary care center were surveyed on orgasm satisfaction (Orgasm Rating Scale), and sexual function (Transmasculine Sexual Functioning Index).

Results: The study sample (n = 20) was largely white, college-educated, between the ages of 21 and 35 years old. Most participants identified as transmasculine/transgender men and 75% were on testosterone therapy. No significant differences were observed in Orgasm Rating Scale subscales. The median Transmasculine Sexual Functioning Index sexual function score (20) corresponded with "moderate" sexual function.

Conclusion: This study should be replicated in a larger, more diverse sample, with stratification across hormone therapy use, and longitudinal follow-up to assess for change in sexual function over time.

Background: Low-intensity extracorporeal shockwave therapy (Li-ESWT) is thought to treat erectile dysfunction (ED) by stimulating neovascularization and nerve regeneration as demonstrated in animal models by histologically increased angiogenesis and neuronal-related growth factors, though corresponding human studies are limited.

Aim: We hypothesized that Li-ESWT results in appreciable increases in growth factors in human tissues, and in this proof-of-concept study we aimed to determine whether markers for neovascularization and nerve regeneration can be detected in the corporal blood of men following Li-ESWT treatment.

Methods: Patients were prospectively enrolled in a clinical trial of Li-ESWT for ED. Patients received 12 bi-weekly Li-ESWT treatments of 0.2 mJ/mm² at 5 Hz, 1500 shocks delivered per treatment, with follow up at 1-2 weeks, 4-6 weeks, 3 months, and 6 months post-treatment. Cavernosal penile blood samples were obtained prior to treatment and at each visit post-treatment. The concentrations of endothelial nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS), vascular endothelial growth factor (VEGF), and brain-derived neurotropic factor (BDNF) in penile plasma samples were measured using enzyme-linked immunosorbent assay with specific commercial kits, following the protocols provided by the manufacturer.

Outcomes: eNOS, nNOS, VEGF, and BDNF were detectable and demonstrated changes in cavernosal plasma samples following Li-ESWT treatment.

Results: Twenty-five patients completed all five study visits. Mean patient age was 63. Mean baseline International Index of Erectile Function-Erectile Function score prior to treatment was 14.24 (±1.21). Corporal plasma samples were analyzed for eNOS, nNOS, VEGF, and BDNF using the enzyme-linked immunosorbent assay. Levels of eNOS, nNOS, and VEGF showed an upward trend following treatment but did not reach significance. BDNF levels were noted to decrease.

Clinical implication: Corporal blood aspirates may function as surrogates for histological studies to understand effects of Li-ESWT at the tissue level in humans.

Strengths and limitations: To our knowledge, this is first the molecular study in human tissues to attempt to quantify neurogenesis and neovascularization in penile tissue following Li-ESWT for ED. Although our sample size is small, we believe this represents a promising first step in understanding the effect of Li-ESWT at a tissue level in men.

Conclusion: The clinical significance of our findings is currently unknown, but markers of neovascularization and neurogenesis are detectable in corporal plasma and may change following Li-ESWT. ClinicalTrials.gov  ID NCT04720755.

Background: Despite guideline recommendations to assess Peyronie's disease (PD) curvature during an intracavernous injection-induced erection, no standardized measurement protocol exists, and considerable interobserver variability remains.

Aim: To evaluate the interobserver reliability of penile curvature measurements in patients with PD and to determine if image annotation enhances measurement consistency.

Methods: In this study, 4 experienced urologists independently assessed erect penile curvature in 22 male patients enrolled in a prospective PD clinical trial. Two image sets per patient were analyzed: 1 consisting of self-captured photographs taken at home and the other obtained in the clinic after intracavernosal injection of alprostadil. Each image set included standardized lateral and dorsal views. The potential impact of an assisting line on photographic measurements was also evaluated.

Outcomes: Interobserver agreement in curvature measurement, the effect of line annotation on measurement accuracy, and the comparison of measurement consistency between home-acquired and clinic-induced erection images.

Results: Interobserver agreement was high, with Intraclass Correlation Coefficient values ranging from 0.77 to 0.88 across assessments. No statistically significant improvement in repeatability was observed with the addition of assisting lines. Furthermore, no meaningful difference in reproducibility was detected between home-based and pharmacologically induced image sets.

Clinical implications: Accurate measurement of penile curvature is crucial for comparing studies and evaluating treatment results. Variations in measurement techniques can lead to inconsistent data interpretation and reduce generalizability.

Strengths and limitations: This study highlights the need to standardize PD curvature assessment. While using multiple expert raters increases reliability, the small sample size and subjective interpretation of curvature may limit its broader use.

Conclusion: Penile curvature measurements in PD show high interobserver reliability, regardless of photographic conditions or the use of assisting lines.

Background: The PLISSIT model has a significant impact on alleviating sexual dysfunction and enhancing sex life.

Aim: This study aimed to investigate the 1-year outcomes of the effect of sexual training-counseling based on the PLISSIT model on the resolution of sexual dysfunction among women using contraceptive methods.

Methods: The study was designed prospective, randomized controlled, and experimental, and carried out in 2 stages. In the first stage, 352 women were included in the study. The Female Sexual Function Index (FSFI) was administered to these women, and their sexual dysfunction status was assessed according to the FSFI cut-off point (≤26.55). And then, 100 women who detected sexual dysfunction were randomized and divided into 2 groups (study group-SG; n = 49 and control group-CG; n = 51). Sexual education-counseling based on the PLISSIT model was implemented only for the SG. At 1-year follow-up, the sexual functions of women in both groups were evaluated with FSFI.

Outcomes: The rate of sexual dysfunction in women using contraceptive methods is important, and PLISSIT-based sexual counseling is effective in reducing this problem.

Results: The sexual dysfunction rate was found to be 28.4% (n = 100). After PLISSIT-based sexual counseling, the sexual functions of the women in the SG improved starting from the third month and the FSFI levels were higher than the CG women at the third month, sixth month, and first year (P < .001). The effect size of PLISSIT-based counseling on the total FSFI score was 37.6%. While in the first assessment, sexual dysfunction rates were 100% in both groups; after 6 months, this rate decreased to 38.8% and 42.9% after 1 year in the SG (in CG, respectively; 94.1% and 80.4%) and the difference was significant (P < .001).

Clinical implications: The results show the importance of sexual function assessment and sexual counseling in women using contraceptive methods, the FSFI can be used in the assessment, and PLISSIT-based sexual counseling was effective in reducing sexual dysfunction.

Strengths and limitations: The limitations of this research are its cross-sectional nature and the fact that it was conducted only with women who use contraceptive methods.

Conclusion: Study results showed that the rate of sexual dysfunction was high in women using contraceptive methods and PLISSIT-based sexual counseling was effective in reducing or resolving sexual dysfunction experienced during contraceptive use.

Background: Although workshops facilitated by a sexual health professional and a priest to support gay Christian men who struggle with accepting their sexuality and religious identity have been organized, the experience of attending such workshops has not been studied.

Aim: To understand the experience of gay Christian men who attended collaborative workshops.

Methods: Six collaborative workshops were conducted between a sexual health clinic and a church in central London from January to September 2018. Purposive sampling was used to recruit 11 gay Christian men who participated in the workshops. Data on their experiences were collected through semistructured interviews, images, and the innovative method of haiku poetry, which was used to reflect on their experiences during and after the workshops. All the data were analyzed using thematic analysis.

Outcome: Gaining insights into the experiences of gay Christian men who participated in collaborative workshops.

Results: The collaborative workshops had a significant impact on gay Christian men in two key areas: self-perception and relationships. The contributing factors to this influence were either environmental or personal. Three themes emerged: motivation, self-development, and the influence of the environment. Some participants embraced the workshops, while others experienced a sense of urgency. The workshops were experienced as fostering their self-growth. In contrast, others were reminded of their destructive behaviors, which left them feeling hopeless. For some participants, the workshop's environment highlighted their minority status as a strength, whereas for others, it highlighted their loneliness.

Clinical implication: This study showed the importance of understanding motivation for attending the collaborative workshops.

Strengths and limitations: Although the findings cannot be generalized to all religious and sexual minorities, they can inform future collaborations. Although a small sample was recruited, it provided an in-depth understanding of the experiences of these men. Limited funding restricted the workshops' accessibility to hard-to-reach communities. The data were analyzed from a psychological perspective.

Conclusion: This study introduces a novel model for integrating religion and sexuality. It adapts Maslow's hierarchy of needs for gay Christian men to include freedom from shame as an essential requirement, subsequently fostering belongingness, connection, and love.