Sexual Medicine最新文献

Background: Previous studies have shown that a small percentage of people in the general population have atypical gender identity and/or sexual orientation.

Aim: This study aimed to explore variations in gender identity and sexual orientation in university students and determine genetic factors associated with these variations.

Methods: Deviations from complete gender congruence and exclusive heterosexual orientation in 736 Japanese university students were quantitatively assessed with self-assessment questionnaires. Next, we conducted genetic tests for 80 participants who showed relatively low gender identity scores and/or atypical sexual orientation. These genetic tests consisted of repeat number analysis of the androgen receptor gene (AR) and a SKAT-O: an optimal unified sequence kernel association test, which is an exome-based rare variant association study. The results of the genetic tests were compared with the Japanese reference data and the results of our 637 control samples.

Outcomes: We calculated the gender identity and sexual orientation scores of all participants and analyzed the molecular data of 80 selected participants.

Results: The gender identity scores of 736 participants were broadly distributed: only ~15% of natal males and ~5% of natal females had the maximum score that corresponds to complete gender congruence. The sexual orientation scores also varied: ~80% of natal males and ~60% of natal females showed exclusive heterosexual orientation. We found no association between gender characteristics and AR repeat numbers. The SKAT-O showed that rare damaging variants of TDRP and 3 other genes were more common in the 80 participants than in the control group.

Clinical implications: Our data support the view that gender is a phenotypic continuum rather than a binary trait.

Strength and limitations: This study quantitatively assessed the gender characteristics of a large cohort of university students. Moreover, we conducted systematic screening for genetic factors associated with gender variations. The weaknesses of the study were the limited analytic power of the questionnaires, the relatively small sample for molecular analyses, and incomplete clinical information and relatively advanced ages of the control group.

Conclusion: This study revealed significant variations in gender identity and sexual orientation in university students, which may be partly associated with variants in TDRP or other genes.

Background: The African Copperbelt is a site of intense artisanal and industrial mining and refining of copper and cobalt.

Aim: We aimed to investigate factors that are possibly associated with erectile dysfunction (ED) in metal miners in the former Katanga province of the Democratic Republic of the Congo.

Methods: In a cross-sectional study of 138 miners and 139 controls (bakers), we administered questionnaires to obtain sociodemographic and occupational data and to assess male sexual function (International Index of Erectile Function [IIEF]) and marital relation quality (Revised Dyadic Adjustment Scale). Furthermore, we measured trace metals in blood and urine, as well as testosterone and thyroid hormones in serum.

Outcomes: Outcomes included the prevalence of questionnaire-derived ED and the relation of ED with individual characteristics, serum testosterone, and environmental factors.

Results: Miners were on average 4 years older than bakers (mean ± SD, 37.5 ± 6.9 vs 33.3 ± 5.7 years). Miners had significantly lower scores than bakers on the IIEF (median [IQR], 66 [49-73] vs 73 [66-74]) and the 3 domains of the Revised Dyadic Adjustment Scale (consensus, satisfaction, cohesion). Free testosterone was significantly lower in miners than bakers (ng/dL; 8.11 [6.90-10.10] vs 10.52 [8.83-12.58]; P ˂ .001). In miners, sex hormone-binding globulin correlated positively with blood Pb and urinary Cd. In a multivariable analysis, mild to moderate ED or moderate ED (IIEF-erectile function score ≤18) was significantly associated with having a mining-related job (adjusted odds ratio [aOR], 2.6; 95% CI, 1.3-5.3), work seniority ˃5 years (aOR, 2.3; 95% CI, 1.1-4.6), alcohol consumption (aOR, 2.8; 95% CI, 1.2-6.7), and aphrodisiacs use (aOR, 4.2; 95% CI, 2.2-8.0). Mediation analysis showed that marital relationship partially mediated the relation between work seniority >5 years in mining and ED.

Clinical implications: The high prevalence of ED found in artisanal mine workers indicates that work-related factors should be considered as possibly contributing, directly or indirectly, to sexual dysfunction in men.

Strengths and limitations: Strengths include being the first epidemiologic study documenting ED with validated questionnaires and its possible determinants, including exposure to toxic metals, among young artisanal miners vs a suitable control group. Limitations are the cross-sectional design with convenience sampling and absence of objective confirmation of ED.

Conclusion: As compared with controls, miners reported poorer sexual function and lower quality of their marital relationship, and they had lower free testosterone levels, which may be due to their high exposure to trace metals.

Background: The loop electrosurgical excision procedure (LEEP) to treat cervical dysplasia (CD) is known to alter the cervical microbiota, the community of bacteria that play a central role in female genital health. Perturbations to the microbiota of the female urogenital tract (FUT), including the urethra, vagina, and cervix, have been linked with symptoms of sexual dysfunction (SD), though correlations among LEEP, the microenvironment, and SD have not yet been described.

Aims: To characterize the FUT microbiota before and after LEEP and investigate possible associations with SD.

Methods: Females undergoing LEEP for CD were recruited to participate in the study. Urinary samples and vaginal and cervical swabs were collected immediately before and 3 months after treatment. Bacterial communities were characterized by 16S rRNA next-generation sequencing. Self-report surveys assessing demographics, medical history, and sexual function were completed at the same intervals.

Outcomes: Microbiota taxonomy and Female Sexual Function Index (FSFI) scores.

Results: Alpha diversity revealed a significant decrease in species richness in the FUT microbiota post-LEEP. Beta diversity demonstrated significant differences among the cervical, urinary, and vaginal microenvironments pre- and post-LEEP. Lactobacillus spp were the dominant microbial genus in the cervical microenvironment pre- and post-LEEP. Although the vaginal and urinary microenvironments were characterized by Prevotella pre-LEEP, they were colonized by Lactobacillus post-LEEP. Following LEEP, some participants experienced a significant increase in proinflammatory bacteria, including the genera Gardnerella, Megasphaera, Sneathia, Parvimonas, and Peptostreptococcus. Others experienced significant decreases in inflammatory and protective bacteria post-LEEP, including Butyricicoccus, Terriporobacter, Intestinimonas, and Negativibacillus. Overall there were no significant changes in pre- and post-LEEP FSFI scores. However, post-LEEP FSFI scores were seemingly associated with changes in inflammatory bacteria in some participants.

Clinical implications: There is an overall reduction in FUT microbiota dysbiosis post-LEEP. However, we show variability as some participants experienced persistent dysbiosis of FUT microbiota and elevated FSFI scores, suggesting that therapies to treat dysbiosis of FUT microbiota may reduce FSFI scores, thereby improving SD symptoms.

Strengths and limitations: We demonstrate novel associations among urogenital sites, microbiota changes, LEEP, and SD. The small sample size and inability of species classification are limitations.

Conclusion: Diverse inflammatory microbiota characterizes CD in the FUT, and LEEP most

Background: Although approximately 41% of women experience sexual dysfunction, limited education on female sexual medicine (FSM) in medical school results in underpreparedness among physicians when addressing these bothersome conditions.

Aim: This study aims to evaluate the extent to which FSM is represented in medical education by examining current preclinical and clinical curricula.

Methods: Preclinical curriculum materials on female sexual anatomy, physiology, and pathology, as well as obstetrics and gynecology clinical materials (syllabi, lecture materials, and supplemental resources), were collected from medical schools in the Chicago area. We utilized previous literature to identify specific components of medical school content to evaluate.

Outcomes: Upon reviewing each institution's curricula, we evaluated materials for topic saturation and assessed goals of each syllabus in terms of required content.

Results: Curriculum materials were collected from 7 medical schools. In the preclinical assessment, 1 institution identified all anatomic components of the clitoris in our review, 4 discussed the physiology of the female orgasm, 3 highlighted the prevalence and epidemiology of female sexual dysfunction (FSD), 3 addressed treatments for FSD, and 1 instructed a genitourinary physical exam specific to assessing FSD. When assessing obstetrics and gynecology clinical materials, 5 institutions included topics related to FSM. Of these, only 1 institution had corresponding required synchronous clerkship time dedicated to these topics as a 1-hour lecture, in addition to an optional online training to third-year clinical students in comprehensive sexual history-taking practices, including screening for FSD. One other institution offered supplemental case-based gynecology modules including vulvovaginal diseases and chronic pelvic pain, though sexual pleasure, arousal, and libido were not included.

Clinical implications: The results of this study highlight the need for the inclusion of standardized curricula related to FSM in medical education to equip future physicians to treat patients with sexual dysfunction.

Strengths and limitations: The strengths of this study include that it is the first of its kind to complete a comprehensive review of FSM curricula at a cohort of undergraduate medical institutions. Its limitations include a small sample size of 7 medical schools limited to 1 geographical area.

Conclusion: Our focused needs assessment of medical schools in the Chicago area reveals inconsistencies in outlined institution-specific course goals related to FSM and thus highlights the need for restructuring the curricula to prepare future physicians to recognize and treat patients with sexual dysfunction.

Background: Erectile dysfunction (ED) occurs in an increasing number of patients after radical prostatectomy and cystectomy, and the phenotypic modulation of corpus cavernosum smooth muscle cells is closely related to ED.

Aim: To determine whether endoplasmic reticulum stress (ERS) is implicated in the phenotypic modulation of ED induced by bilateral cavernous nerve injury (BCNI).

Methods: In total, 36 Sprague-Dawley rats were randomly divided into 3 groups: sham, in which rats received sham surgery with bilateral cavernous nerve exposure plus phosphate-buffered saline; control, in which rats received BCNI plus phosphate-buffered saline; and experimental, in which rats received BCNI plus 4-phenylbutyric acid. Analysis of variance and a Bonferroni multiple-comparison test were utilized to evaluate differences among groups.

Outcomes: Erectile function, smooth muscle/collagen ratios, and the expression levels of phenotypic modulation and ERS were measured.

Results: Two ratios-maximum intracavernosal pressure/mean arterial pressure and smooth muscle/collagen-were decreased in the control group as compared with the sham group. In penile tissue, there was increased expression of GRP78 (78-kDa glucose-regulated protein), p-PERK/PERK (phosphorylated protein kinase R-like endoplasmic reticulum kinase/protein kinase R-like endoplasmic reticulum kinase), caspase 3, CHOP (C/EBP homologous protein), and OPN (osteopontin) but decreased expression of nNOS (neuronal nitric oxide synthase) and α-SMA (α-smooth muscle actin). As compared with the control group, erectile function was improved and pathologic changes were partially recovered in the experimental group.

Clinical translation: The present study demonstrated that ERS is involved in ED caused by cavernous nerve injury, thereby providing a new target and theoretical basis for clinical treatment.

Strengths and limitations: The present study demonstrated for the first time that ERS is related to ED caused by cavernous nerve injury. Inhibition of ERS reverses phenotypic modulation and improves erectile function in rats with BCNI. Additional in vitro studies should be performed to verify these conclusions and explore the specific mechanism of phenotypic modulation.

Conclusion: The present study demonstrated that inhibiting ERS reverses phenotypic modulation and enhances erectile function in rats with BCNI.

Background: Due to the sensitivity and potential embarrassment of discussing erectile dysfunction (ED) in person, men are seeking treatment online.

Aims: We sought to compare offerings of direct-to-consumer (DTC) platforms for ED treatment with respect to consultation, pricing, services, and privacy policy.

Methods: Google was queried to identify DTC platforms offering ED treatment with the keywords: "telehealth erectile dysfunction," "telemedicine erectile dysfunction," and "online erectile dysfunction." Inclusion criteria were as follows: serving a majority of U.S. states, existing online only, providing both the consultation and prescription for phosphodiesterase type 5 inhibitors, and delivering the prescription to the patient.

Results: Fifteen DTC platforms met criteria. Ten provided free consultations; 4 bundled the consultation fee with the first month of the prescription, with 1 of these functioning as a subscription service. Fourteen (93%) relied on online intake forms and 10 (67%) advertised review by the prescriber within 2 business days. Only 4 (27%) platforms explicitly advertised physician-only consults. Direct contact with the prescriber would only occur if needed or if required by state law at 8 (53%) platforms. Purchasing sildenafil and tadalafil was advertised on all platforms. Minimum prices of sildenafil ranged from $0.50 to $35/pill (mean $5.16/pill, median $2.65/pill); tadalafil ranged from $0.50 to $9.80/pill (mean $4.70/pill, median $3.21/pill). In addition to ED therapy, 13 (86%) platforms offered treatment for other men's health issues. All platforms included a website privacy policy, but only 10 (67%) mentioned Health Insurance Portability and Accountability Act compliance, with 2 of these claiming to not be covered entities.

Conclusion: Although DTC platforms are transparent with phosphodiesterase type 5 inhibitor medication and subscription pricing information, few offer direct contact with a physician to further discuss issues related to ED after completion of the online intake form. For comprehensive evaluation of ED in Health Insurance Portability and Accountability Act-compliant settings, in-person or telemedicine visits should be arranged with men's physicians.

Introduction: Animal models are frequently used for translational research in Peyronie's disease (PD). However, due to lack of availability of guidelines, there is some heterogeneity in study design, data reporting, and outcome measures.

Aim: This European Society for Sexual Medicine consensus statement aims to provide guidance in utilization of animal models in PD research in a standardized and uniform fashion.

Methods: PubMed was searched for studies using animal models for PD. The following search terms were used: ("Peyronie's disease" OR "penile fibrosis" OR "penile curvature" OR "induration penis plastica" OR "erectile dysfunction") AND ("rodent" OR "mouse" OR "mice" OR "rat" OR "rabbit").

Outcomes: This European Society for Sexual Medicine statement describes best practice guidelines for utilization of animals in PD research: power calculation, details of available models, surgical procedures, and measurement techniques, while highlighting possible pitfalls and translational limitations of the models.

Results: In total, 2490 studies were retrieved and 2446 articles were excluded. A total of 44 studies were included, of which 40 studies used rats, 1 study used both rats and mice, 1 study used a genetic mouse model, and 2 studies used rabbits. A significant number of the studies (70.5%) used transforming growth factor β 1 for induction of fibrosis. Oxford 2011 Levels of Evidence criteria could not be applied due to the nature of the studies.

Conclusion: Despite certain limitations of PD animal models presented, we aimed to provide guidance for their appropriate use in translational research, with the purpose of improving study quality and reproducibility as well as facilitating interpretation of reported results and conclusions.

Background: Physicians often report low levels of confidence in diagnosing and treating female sexual dysfunction (FSD), which may stem from inadequate education and exposure to the topic.

Aim: The study sought to determine the extent to which FSD is covered in undergraduate medical education and evaluate student comfort with the topic and familiarity with treatments.

Methods: We created a novel, 50-question survey to be administered online to any current U.S. medical student. Obstetrician-gynecologist clerkship directors at 146 U.S. medical schools were contacted and asked to invite any current student at their school to participate. A link to the electronic REDCap (Research Electronic Data Capture) survey was distributed to eligible students via the clerkship directors. The survey collected data regarding (1) coverage of FSD and male sexual dysfunction (MSD) in preclinical and clinical curricula, (2) student self-ratings of comfort in hypothetical scenarios in which a patient exhibits symptoms of FSD or MSD, and (3) student familiarity with treatments for FSD and MSD.

Outcomes: Outcomes included the proportion of students reporting that their school covered FSD/MSD in its preclinical/clinical curriculum, the mean comfort ratings for each of the FSD and MSD scenarios, and the proportion of students indicating knowledge of various FSD and MSD treatments.

Results: A smaller proportion of students (N = 236) reported receiving instruction in FSD (58.5%) compared with MSD (78.4%) in their preclinical curriculum (P < .001). Students' average self-ratings of comfort in the sexual dysfunction scenarios were significantly lower for patients with symptoms of FSD compared with MSD (P < .001). Students had higher average self-ratings of confidence in FSD scenarios if their intended specialty was obstetrician-gynecologist (P = .003), if their school included FSD in its clinical curriculum (P = .01), and if they had ever participated in the care of a patient with FSD (P = .006).

Clinical implications: There are important gaps in the coverage of FSD in undergraduate medical education that may be mitigated through improvements to curriculum and increased exposure to patients with FSD.

Strengths and limitations: This is the first study, to our knowledge, to directly survey medical students regarding their educational experience and comfort with FSD. Our study was limited by a small sample size, the use of a novel and nonvalidated questionnaire, and the potential for bias given our sampling method.

Conclusion: Medical schools must work toward improving instruction in FSD for their students to address these disparities and improve students' comfort with the topic.

Background: Chronic pain can occur in the vulva, one of the primary pleasure centers of the body; however, the associations between pleasurable vulvar experiences and chronic vulvar pain have not yet been explored.

Aim: The aim of this study was to investigate associations between vulvar pleasure and pain experiences in patients with chronic vulvar pain.

Methods: This was a prospective cross-sectional study of 547 patients (aged ≥17 years) presenting over 10 months to 2 urban outpatient gynecology clinics specializing in vulvar pain. Prior to the initial evaluation, patients completed online validated questionnaires of pain-related anxiety, pain catastrophizing, and sexual functioning, as well as a researcher-developed questionnaire evaluating vulvar pleasure. Patients were divided into groups based on their pleasure and pain experiences. Between-group analyses consisting of t-tests, analyses of variance, and multivariate analyses of variance were conducted.

Outcomes: Outcomes consisted of total and subscale scores on the Pain Anxiety Symptoms Scale-20, Pain Catastrophizing Scale, Female Sexual Function Index, and a researcher-developed vulvar pleasure questionnaire.

Results: More than 70% of patients with chronic vulvar pain had experienced vulvar pleasure since the onset of their vulvar pain, with the clitoris as the most common source of pleasure. Average vulvar pleasure intensity was rated 7 (0, no pleasure; 10, extremely pleasurable). Masturbation ranked higher in pleasurable activities than vulvar stimulation by a partner or penetrative intercourse and was the most likely activity to lead to orgasm. When compared with patients who had not experienced vulvar pleasure since the onset of their vulvar pain, patients experiencing both pain and pleasure scored lower on the Pain Anxiety Symptoms Scale-20 total (P = .026) and fear subscale (P = .016), lower on the Pain Catastrophizing Scale total (P = .002) and all subscales (P = .008-.018), and higher on the Female Sexual Function Index total and all subscales (all P ≤ .001).

Clinical implications: Incorporating strategies for cultivating vulvar pleasure in patients with chronic vulvar pain may be useful in comprehensive management approaches.

Strengths and limitations: Strengths of this study include the novel examination of vulvar pleasure in a population with chronic vulvar pain and a large sample size. Limitations include the lack of a nonclinical comparator group and reliance on patient self-report.

Conclusion: Results suggest that greater vulvar pleasure is associated with lower pain-related anxiety, lower pain catastrophizing, and higher sexual functioning in patients with chronic vulvar pain conditions.

Background: Delayed ejaculation (DE) is a disorder that can cause significant distress for sexually active men. The etiology of DE is largely idiopathic, with even less being known about clinical factors associated with the condition.

Aim: We sought to use data mining techniques to examine a broad group of health conditions and pharmaceutical treatments to identify factors associated with DE.

Methods: Using an insurance claims database, we evaluated all men with a diagnosis of DE and matched them to a cohort (1:1) of men with other male sexual disorders of urologic origin (ie, erectile dysfunction [ED] and Peyronie's disease [PD]). Given the low prevalence of DE, we incorporated the random forest approach for classification of DE vs controls, with a plethora of predictors and cross-validation with the least absolute shrinkage and selection operator (LASSO). We used both a high-performance generalized linear model and a multivariate logistic model. The area under the curve was reported to demonstrate classifier performance, and odds ratios were used to indicate risks of each predictor. We also evaluated for differences in the prevalence of conditions in DE by race/ethnicity.

Outcomes: Clinical factors (ie, diagnoses and medications) associated with DE were identified.

Results: In total, 11 602 men with DE were matched to a cohort of men with PD and ED. We focused on the 20 factors with the strongest association with DE across all models. The factors demonstrating positive associations with DE compared to other disorders of male sexual dysfunction (ie, ED and PD) included male infertility, testicular dysfunction, anxiety, disorders of lipid metabolism, alpha adrenergic blocker use, anemia, antidepressant use, and psychoses such as schizophrenia or schizoaffective disorder. In addition, the prevalence of several conditions varied by race/ethnicity. For example, male infertility was present in 5% of Asian men compared to <2% of men of other races.

Clinical implications: Several medical conditions and pharmacologic treatments are associated with DE, findings that may provide insight into the etiology of DE and offer treatment options.

Strengths and limitations: This study is to our knowledge the first to use using data mining techniques to investigate the association between medical conditions/pharmacologic agents and the development of subsequent DE. The generalizability of our findings is limited given that all men were commercially insured.

Conclusion: DE is associated with multiple medical conditions, a finding that may help identify the etiology for this disorder.