Sexual Medicine最新文献

Background: Since the outbreak of COVID-19 disease, the environment, families, individuals, and their ways of living have been affected. Social distancing was one of the strategies for the prevention of SARS-CoV-2 infection. It led to limited social interactions for fear of contracting the infection, which ultimately affected relationships, among which is sexual health.

Aim: To determine the risk of female sexual dysfunction and the effect of the COVID-19 pandemic on sexual function and activities among women of reproductive age in Ibadan, South-West Nigeria.

Methods: This cross-sectional study of 218 reproductive-age women evaluated the sexual function before, during, and after the COVID-19 disease pandemic and lockdown. Pretested semistructured self-administered questionnaires with the Female Sexual Function Index (FSFI) were used for data collection. Information collected included sociodemographic and gynecologic characteristics and COVID-19 experiences, as well as sexual history and function before, during, and after the COVID-19 pandemic lockdown. The level of significance was set at P < .05.

Outcomes: Respondents were aged 20 to 50 years (95%) with a mean ± SD age of 34.82 ± 8.52 years; the majority were married (75.58%); one-fifth (21.9%) tested positive for COVID-19 infection; and participants who tested positive for COVID-19 infections were mostly health care workers.

Results: An absence of sexual activity was reported in 9.18% of participants during lockdown, 7.73% before lockdown, and 4.18% after lockdown. The risk of female sexual dysfunction was prevalent among participants, especially those who tested positive for COVID-19 infection. The prevalence was worse during the pandemic lockdown (53.57%) than before (48.39%) or after (51.61%), and a similar pattern was seen among those who tested negative. There was no statistically significant difference in risk of developing sexual dysfunction during the COVID-19 pandemic between those who tested positive and negative to COVID-19. The arousal and desire domains contributed the highest proportion of low FSFI scores.

Clinical implications: Nationwide lockdowns, which may be a method of control for pandemics, may result in psychosocial complications such as female sexual dysfunction.

Strength and limitations: Most respondents had tertiary education and were able to respond to self-administered questionnaires, yet the risk of recall bias remains a concern whereas the pandemic met the world unprepared and baseline FSFI prior the pandemic was not available for participants. There are no local validation studies for the FSFI in Nigeria, which could have aided interpretation of results.

Conclusion: A low FSFI score is prevalent in Ibadan, South-West Nigeria, with a higher incidence reported during the COVID-19 pa

Background: Previous observational studies have found a potential link between prostate disease, particularly prostate cancer (PCa), and kidney disease, specifically chronic renal disease (CKD), in relation to erectile dysfunction (ED), yet the causal relationship between these factors remains uncertain.

Aim: The study sought to explore the potential causal association between prostate diseases, renal diseases, renal function, and risk of ED.

Methods: In this study, 5 analytical approaches were employed to explore the causal relationships between various prostate diseases (PCa and benign prostatic hyperplasia), renal diseases (CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, and kidney ureter calculi), as well as 8 renal function parameters, with regard to ED. All data pertaining to exposure and outcome factors were acquired from publicly accessible genome-wide association studies. The methods used encompassed inverse variance weighting, MR-Egger, weighted median, simple mode, and weighted mode residual sum and outlier techniques. The MR-Egger intercept test was utilized to assess pleiotropy, while Cochran's Q statistic was employed to measure heterogeneity.

Outcomes: We employed inverse variance weighting MR as the primary statistical method to assess the causal relationship between exposure factors and ED.

Results: Genetically predicted PCa demonstrated a causal association with an elevated risk of ED (odds ratio, 1.125; 95% confidence interval, 1.066-1.186; P < .0001). However, no compelling evidence was found to support associations between genetically determined benign prostatic hyperplasia, CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, kidney ureter calculi, and the renal function parameters investigated, and the risk of ED.

Clinical implications: The risk of ED is considerably amplified in patients diagnosed with PCa, thereby highlighting the importance of addressing ED as a significant concern for clinicians treating individuals with PCa.

Strengths and limitations: This study's strength lies in validating the PCa-ED association using genetic analysis, while its limitation is the heterogeneity in study results.

Conclusion: The results of this study suggest a potential link between PCa and a higher risk of ED.

Background: The significance of geographic barriers to receiving inflatable penile prosthesis (IPP) treatment is uncertain according to the existing medical literature.

Aim: To describe the travel patterns of men with erectile dysfunction (ED) in the United States who underwent IPP surgery.

Methods: This retrospective cohort study utilized data from the 100% Medicare Standard Analytical Files. Men aged ≥65 years with an ED diagnosis who underwent IPP surgery between January 2016 and December 2021 were identified from the database. Federal Information Processing Series codes from the National Bureau of Economic Research's County Distance Database were used to determine geographic distances from patients' homes to the facilities at which surgery was performed.

Outcomes: Evaluations included the proportions of men who traveled outside their county of residence or state for IPP treatment and the average distances in miles traveled.

Results: Among 15 954 men with ED undergoing IPP treatment, 56.4% received care out of their county for IPP, at a mean distance of 125.6 miles (range, 3.8-4935.0). Although patients aged ≥80 years were less likely to travel outside their county as compared with men aged 65 to 69 years (48.1% vs 57.1%, P < .001), if they traveled, they were likely to travel farther (mean, 171.8 vs 117.7 miles; P < .001). South Dakota had the highest proportion of men traveling outside their county for IPP treatment (91.3%; mean, 514.2 miles), while Vermont had the highest proportion traveling outside their home state (73.7%).

Clinical implications: By unveiling disparities in access, this study will potentially lead to tailored interventions that enhance patient care and health outcomes.

Strengths and limitations: Strengths include the uniqueness in (1) evaluating the proportions of patients who travel out of their county of residence or home state for IPP treatment and (2) quantifying the average distances that patients traveled. An additional strength is the large sample size due to the retrospective design and database used. The analysis did not capture all Medicare enrollees; however, it did encompass all traditional Medicare enrollees, representing approximately half of all men in the US aged ≥65 years. Limitations include not being generalizable to entire population of the US, as the study examined only Medicare enrollees. In addition, the study period includes the pandemic, which could have affected travel patterns. Furthermore, the coding and accuracy of the data are limitations of using administrative claims data for research.

Conclusion: Study findings showed that many men with Medicare and ED traveled from their home geographic location for IPP treatment.

Background: Cell therapy (CT) is a form of regenerative medicine under investigation for the management of male sexual dysfunction (MSD).

Aim: We sought to perform a systematic review of published information on CT for MSD and provide an official position statements for the European Society for Sexual Medicine.

Methods: A comprehensive bibliographic search on the MEDLINE, Web of Science, Scopus, and Cochrane Library databases was conducted in February 2023. Articles were selected based on the Population, Intervention, Comparator, Outcome, Study design (PICOS) model if they included male patients (P) undergoing CT (I) with or without comparison with other treatments (C) and evaluated the impact of CT on sexual function (O). Quantitative data were reported as found in the original studies (S). Level of evidence and grade of recommendation according to the Oxford Centre for Evidence-Based Medicine were assigned to each statement.

Outcomes: Outcomes were determined based on assessment of erectile function, ejaculatory function, orgasmic function, sexual desire, and penile curvature.

Results: A total of 19 studies and 421 patients were included. Most articles (n = 12, 63%) were case series, whereas a minority of papers (n = 6, 32%) had a comparative group; only 2 articles reported randomized controlled trials (RCTs) and 1 article reported a post hoc analysis of RCTs. Most articles (16, 84%) investigated patients with erectile dysfunction (ED). Improvements in the International Index of Erectile Function-Erectile Function Domain (IIEF-EF) or the IIEF 5-item version (IIEF-5) were found in 11/15 (73%) studies, with mean increases in IIEF-EF, mean IIEF-5, and median IIEF-EF between 8 and 14 points, 2 and 9 points, and 4.5 and 6 points, respectively. Two papers (20%) evaluated men with Peyronie's disease (PD). In both ot these articles penile curvature improvement and plaque volume reduction were described in all patients (n = 16, 100%). Objective measurements were performed in 1 study, which showed 10°-120° (15%-100%) curvature improvement and 90%-100% plaque reduction. Mild transient adverse events at the donor or administration sites were found in 7/16 (44%) papers on ED. Priapism was reported in one case (20%) and mild penile skin complications were reported in the majority of patients after CT for PD. No severe adverse events were described.

Clinical implications: Although high-quality evidence is lacking, CT appears to have potential benefits from application in patients with ED or PD.

Strengths and limitations: This report is to our knowledge the most comprehensive and up-to-date systematic review on the topic of CT for the management of MSD, including the position statements of the European Society for Sexual Medicine. Overall the assessment of available studies demonstrated low quality and si

Background: Avanafil is a second-generation phosphodiesterase type 5 (PDE5) inhibitor, and offers a rapid onset of action (15 minutes). Its real-world data, including treatment satisfaction, are still lacking.

Aim: The study sought to investigate the treatment outcomes of avanafil and the factors impacting treatment satisfaction in a real-world setting.

Methods: Between November 2021 and February 2023, erectile dysfunction (ED) patients prescribed avanafil were consecutively enrolled in this phase 4, open-label, cross-sectional, observational study. At each follow-up visit (4-week intervals), participants completed a questionnaire for assessing the use and treatment-emergent adverse events of avanafil, ED severity, and treatment satisfaction.

Outcomes: The outcome measures included the Sexual Health Inventory for Men (SHIM), and Erectile Dysfunction Inventory of Treatment Satisfaction.

Results: Among 234 patients enrolled, 112 (47.9%) patients had follow-up visits and answered the questionnaire. Treatment with avanafil significantly improved the mean SHIM total score from 10.2 ± 5.6 at baseline to 17.5 ± 6.2 (P < .001). Of the patients treated with avanafil, 71.4% (n = 80 of 112) reported a >4-point improvement in the SHIM total score, and 33.1% (n = 37 of 112) reported normal erectile function. The proportion of patients satisfied with avanafil treatment (defined as Erectile Dysfunction Inventory of Treatment Satisfaction index score ≥60) was 87.5%. Several physical factors (younger age, lower waist circumference, and lower level of low-density lipoprotein), and sexual function factors (shorter duration of ED, higher SHIM total score at baseline, PDE5 inhibitor treatment naive, and acquired premature ejaculation) tended to contribute to satisfaction with avanafil treatment. Treatment-emergent adverse events occurred in 41.1% of patients, and all were mild in severity.

Clinical implications: This study identifies the factors associated with treatment satisfaction of avanafil, which may ultimately lead to better treatment outcomes.

Strengths and limitations: This is the first study to provide real-world evidence of avanafil for ED treatment, and validated questionnaires were used to assess erectile function and treatment satisfaction. However, the limitations of this study include single-center observational study design, small sample size, and short-term follow-up.

Conclusion: Avanafil is an effective treatment for ED, and satisfaction rate is high in an outpatient setting. The awareness of identified factors related to patient satisfaction may improve treatment outcomes.

Background: It is difficult to diagnose hypogonadism because of the lack of objective assessments of erectile dysfunction (ED), which is caused by hypogonadism.

Aim: To provide a new approach for diagnosing hypogonadism, this study evaluated the efficacy of nocturnal penile tumescence and rigidity (NPTR) testing with RigiScan for patients with ED with and without hypogonadism.

Methods: From June 2021 to February 2023, 133 patients with ED (62 with hypogonadism and 71 without) underwent NPTR testing at the Department of Andrology. A detailed history of all participants was obtained. All participants also underwent a physical examination, sex hormone testing, and ultrasound examination of the cavernous vessels of the penis.

Outcomes: Patient characteristics, sex hormone serum levels, and RigiScan Plus data of NPTR testing of patients with ED were obtained and evaluated.

Results: Between the groups, there were no significant differences in age, body mass index, or erectile function score or in the prevalence of smoking, drinking, diabetes, hypertension, and hyperlipidemia. RigiScan data revealed differences in erection episodes per night, average event rigidity, erection durations, and percentage of tumescence greater than baseline, which were significantly lower in the testosterone-deficient group than in the normal testosterone group. The average event rigidity of the tip displayed the largest area under the curve value, with a sensitivity of 67.6%, a specificity of 85.5%, and a cutoff value of 52.50.

Clinical implications: Our findings may allow appropriate patients to receive testosterone replacement therapy, which has been shown to be an effective treatment for hypogonadism.

Strengths and limitations: This is the first study of its kind to perform a comprehensive review of the association between hypogonadism and RigiScan parameters. This study was limited by its small sample size.

Conclusion: RigiScan parameters of patients with ED and testosterone deficiency were significantly lower than those of patients with normal testosterone; therefore, RigiScan is useful for the differential diagnosis of patients with ED caused by hypogonadism.

Background: Observational studies have indicated a high prevalence of erectile dysfunction (ED) among patients with inflammatory bowel disease (IBD), but a definitive causal relationship remains unestablished.

Aim: The primary aim of this study was to assess the potential causal relationship between IBD and ED using Mendelian randomization (MR) analysis.

Methods: We obtained statistical data for 2 subtypes of IBD, ulcerative colitis (UC) and Crohn's disease (CD), as well as for ED, from publicly available genome-wide association studies (GWASs). Subsequently, a 2-sample MR analysis was conducted using these datasets. The primary MR analysis utilized the inverse variance-weighted (IVW) method, complemented by secondary analyses employing MR-Egger and weighted median methods. Furthermore, we assessed heterogeneity using Cochran's Q test and evaluated pleiotropy with the MR-Egger intercept test. To identify potential influential single nucleotide polymorphisms, we employed a leave-one-out analysis. Additionally, outliers were identified using the MR-PRESSO method.

Outcomes: The study outcomes encompassed results from 3 MR analyses, namely IVW, MR-Egger, and weighted median, along with sensitivity analyses involving Cochran's Q test, the MR-Egger intercept test, leave-one-out analysis, and the MR-PRESSO method.

Results: There was no causal effect of UC and CD on ED in the MR analysis (IVW P > .05). Results of complementary methods were consistent with those of the IVW method. The results of sensitivity analyses supported our conclusion, and no directional pleiotropy was found.

Clinical implications: Genetically, despite the absence of a causal link between IBD and ED according to MR analysis, we must emphasize the elevated ED prevalence among IBD patients in observational studies, with particular consideration for the influence of negative emotions on erectile function.

Strengths & limitations: This study is the inaugural application of a 2-sample MR analysis using extensive GWAS datasets to evaluate the causal relationship between IBD and ED, effectively mitigating biases stemming from confounding factors and reverse causality often present in observational studies. Nevertheless, it is imperative to exercise caution when drawing conclusions due to inherent limitations in GWAS data, encompassing factors like samples overlap, gender categorization, population ancestry, and the persistent ambiguity surrounding the precise functionality of specific single nucleotide polymorphisms.

Conclusions: MR analysis did not provide genetic-level evidence supporting a direct causal relationship between IBD (UC and CD) and ED.

Background: Several studies have been published to present normal values of female genitalia in different age and racial groups.

Aim: The primary objective of our study was to measure the parameters of the external genitalia in adult Iranian women, record the data using the Labiagram system (the first national Labiagram design in Iran), and establish a preliminary database.

Methods: A descriptive study was conducted from March 2022 to December 2022, involving 220 nonpregnant adult women who presented to the gynecology clinic. Women who met the inclusion criteria for the study underwent a comprehensive examination of the external genitalia. The data collected during the examinations were recorded in electronic files and the Labiagram system.

Outcomes: The data showed the diversity of external genital parameters of nonpregnant adult Iranian women.

Results: In this descriptive study, the mean ± SD age of the participants was 51.5 ± 13.44 years, ranging from 15 to 84 years. A total of 192 women (87.3%) had a history of vaginal delivery. There was no statistically significant difference observed in the average measurements of the vulva among the 4 age groups (P < .05). The Pearson correlation coefficient test indicated a statistically weak correlation between body mass index and perineum length (r = 0.174, P = .010). Additionally, a weak correlation was found between body mass index and the width of the labia minora at the left-lower point (r = 0.143, P = .030) and the right-middle point (r = 0.146, P = .031). Furthermore, the results demonstrated that women with a history of vaginal delivery had a significantly longer introitus (49.3 vs 44.3 mm, P = .037), longer labia majora (91.3 vs 87.3 mm, P = .046), and longer labia minora (56.8 vs 50.9 mm, P = .008) when compared with women without prior labor experience.

Clinical implications: The data will be used as a basis for future studies.

Strengths and limitations: The use of simple tools for the measuring, data recording, and digital drawing of female external genital anatomy, along with privacy protection, is one of the strengths of this research. The weakness is the small sample size, which is the reason for piloting the Labiagram chart for more extensive studies.

Conclusion: Increasing age and the number of births had no statistically significant effect on the size of external genital parameters among Iranian women. Despite the considerable diversity in these parameters, it has not resulted in a significant demand among Iranian women for female cosmetic surgery.

Background: Atherosclerosis and insulin resistance play an important role in the development of erectile dysfunction (ED), and few studies have comprehensively evaluated more specific indicators like atherogenic indices and the triglyceride-glucose (TyG) index in the assessment of ED.

Aim: This study aimed to reveal the role of atherogenic indices (atherogenic index of plasma [AIP], Castelli risk index-1/2 [CRI-1/2], and atherogenic coefficient [AC]) based on plasma lipid ratios, which have been used as more sensitive indicators of atherosclerosis in recent years, and the TyG index, a practical indicator of insulin resistance, in predicting vasculogenic ED.

Methods: The study included a total of 199 patients who met the inclusion criteria and a total of 51 control subjects without ED complaints according to the International Index of Erectile Function (IIEF-5) scores (>21) between May 2021 and October 2022. For all participants, the demographic and biochemical parameters were evaluated, and atherogenic indices, namely CRI-1 (total cholesterol/high-density lipoprotein [HDL]), CRI-2 (LDL/HDL) AIP [log10(triglycerides/HDL)], and AC (non-HDL/HDL), as well as the TyG index [Ln {fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2}] were calculated.

Outcomes: The TyG index, which is an indicator of insulin resistance, and atherogenic indices such as CRI-1, AIP, and AC were significantly associated with ED, and especially AIP and the TyG index seem to be more important in the evaluation of ED.

Results: According to the univariate analysis, the patient group had significantly higher CRI-1 (5.3 ± 1.4 vs 4.7 ± 1.3; P = .005), AIP (0.31 ± 0.26 vs 0.13 ± 0.2; P < .001), AC (4.1 ± 1.4 vs 3.70 ± 1.2; P = .026), and TyG (9.16 ± 0.71 vs 8.77 ± 0.52; P < .001) values compared with the control group. In the correlation analysis, a significant negative correlation was found between the AIP and TyG index and the IIEF-5 scores (r² = 0.120, P < .001 between AIP and IIEF-5; r² = 0.091, P < .001 between TyG index and IIEF-5). The multivariate analysis revealed AIP and the TyG index as independent predictive factors for ED.

Clinical implications: The use of atherogenic indices and TyG index in daily urology practice can help physicians in the diagnosis and follow-up of ED.

Strengths and limitations: The lack of sex hormone-binding globulin and free testosterone levels represents a limitation of our study. Another limitation is that the severity of ED was determined using the IIEF-5 scores, rather than a more objective method, such as penile artery ultrasound.

Conclusion: Atherogenic indices and the TyG index can be used as inexpensive and practical markers to predict the severity of arteriogenic ED.