Sexual Medicine最新文献

Background: Peyronie's disease (PD) is a fibroproliferative disorder that causes an abnormal curve of the penis resulting in pain, discomfort, and erectile dysfunction with management options including correctional surgery, penile external/internal devices, shock wave therapy (SWT), intralesional Verapamil (IV), and collagenase Clostridium histolyticum injections.

Aim: To investigate the insurance coverage of these treatment options.

Methods: The authors performed a cross-sectional analysis of the top US insurance policies for coverage of PD. Companies were chosen based on their market share and enrollment. Their policies were identified through a Web-based search and telephone interviews, and the companies' medical necessity criteria were defined. The online policies were then re-examined for interval change 3 years later.

Outcomes: There are significant discrepancies for in coverage for the different modalities of Peyronie's treatment.

Results: Of the 100 companies examined, only 54% of companies had a policy that directly addressed the treatment coverage for PD. The most covered treatment was CCH injections with 37 companies providing unanimous coverage (n = 37, 100%). Within this category, all companies required a palpable plaque as a requirement. Additionally, external/internal devices were unanimous covered by 18 companies (n = 18, 100%). Surgical treatment was covered by eight companies with six companies denying coverage (n = 8 vs. n = 6, 57.1% vs. 42.9%). IV was covered by two companies. The least covered treatment option was SWT which was universally denied by 19 companies (n = 19, 100%).

Clinical implications: Insurance coverage of PD should be aligned with current medical literature to better increase access to care.

Strengths & limitations: This study is limited by the updated policies of insurance companies and future applicability. Additionally, this study assumes that a written policy will provide coverage and may overestimate the actual extent of coverage. Finally, this study only addressed some of the common treatment options of PD and did not expand on all possible treatment options.

Conclusion: Differing rates for modalities of treatment may present a barrier for patients to receive individualized and adequate treatment for PD.

Introduction: Hormonal, behavioral, psychological, surgical, and pharmacopsychological treatment approaches contribute to female sexual dysfunction (FSD). Aim: The study is conducted to assess the effectiveness of hyaluronan high and low molecular weight hybrid cooperative complexes (hybrid H-HA/L-HA) in treating females with SD and to compare the female sexual function index (FSFI), dermatological life quality index (DLQI), and female genital self-image scale (FGSIS) before and after therapy.

Methods: We divided the 60 female participants into two groups. Hybrid H-HA/L-HA was administered to form pili of 0.25 cc around the clitoris in the direction of clock positions of 12, 3, 6, and 9. In Skene's gland; 0.25 cc for each and 0.5 cc into the corpus/body of the clitoris. Two treatments were held 30 days apart.The same procedure was repeated on the control group, but with saline as a placebo.

Outcomes: Women completed self-report questionnaires assessing sexual functioning using the FSFI, DLQI, and FGSIS before and after therapy.

Result: There was a significant (P = 634.152; P < .05) increase in the study group's weekly sexual interactions compared with the controls. The study group showed statistically significant amelioration in desire, arousal, lubrication, orgasm, satisfaction domains, overall score, and a decrease in pain following the first and second injection sessions (P = .014, .031, .003, .001, .011, .004, and .011, respectively). A comparison of the results between the two groups revealed significant improvement were found (P = .025).There were significant improvements in the domains of the FGSIS compared with the controls (P = .026). The study group showed a substantial improvement in satisfaction with the way their genital area looked, comfort level when allowing a sexual partner to view their genital area, belief that their genitals smell perfectly fine without being self-conscious about them, and overall score (P = .022, .031, .003, .001, and .004, respectively) (P < .05).The hybrid H-HA/L-HA sessions resulted in significantly greater positive perceptions and feelings, leisure activities, interpersonal interactions, and general assessments (P = .021, .021, and .020, respectively) (P < .05).

Clinical implications: Female individuals with SD experience sexual improvements after hybrid H-HA/L-HA injection.

Strengths and limitations: This is the first study focusing on female individuals with SD. We recommend conducting the study on a larger population and including their partners.

Conclusion: Hybrid H-HA/L-HA injection for rejuvenating the clitoral injection appears to be a reliable and safe method for enhancing female genital self-image, sexuality, and quality of life.

Introduction: 45,X/46,XY mosaicism is a rare anomaly in sexual differentiation, presenting with diverse phenotypes and often leading to infertility due to abnormal gonadal development.

Aims: This report aims to present a case study of a 45,X/46,XY mosaic male patient with an ejaculatory disorder attributed to seminal vesicle dysplasia.

Methods: In this case study, diagnostic procedures encompassed blood tests, semen analysis, chromosomal examination, and imaging studies to assess gonadal morphology. Treatment strategies included attempted varicocelectomy, pharmacological intervention with amoxapine, and surgical testicular sperm extraction. Additionally, the patient underwent assisted reproductive techniques, specifically intracytoplasmic sperm injection (ICSI), to facilitate pregnancy for his wife.

Results: A 32-year-old man could not ejaculate, with post-orgasmic urinalysis revealing minimal sperm presence. Chromosomal analysis confirmed 45,X/46,XY mosaicism. Despite undergoing microsurgical varicocelectomy for clinical varicocele and receiving tricyclic antidepressants, no improvement in semen volume occurred. Imaging studies indicated ejaculatory disorder due to prostate and seminal vesicle aplasia. Consequently, surgical retrieval of testicular sperm was performed, leading to successful pregnancy via ICSI for his wife.

Conclusion: Our approach has effectively addressed ejaculatory disorder in 45,X/46,XY mosaic men, resulting in successful pregnancy.

Background: Multiple sclerosis (MS) is a recurrent, autoimmune, and inflammatory demyelinating chronic disease that typically manifests in young adulthood and exerts adverse effects on sexual functions.

Aim: The study evaluated the prevalence of sexual dysfunctions (SDs) and the relationship with neurological disability, depression, and lower urinary tract symptoms (LUTS) in a cohort of MS female patients, comparing these results with those of healthy women.

Methods: From January 2023 to January 2024, consecutive premenopausal female patients with MS, were recruited and the examination included urinalysis, ultrasonography and a urodynamic test according to the International Continence Society standard.

Outcomes: Descriptive statistics were reported as mean and standard deviation for continuous variables (analyzed by independent samples Mann-Whitney U test and independent samples Kruskal-Wallis test) while categorical variables were reported as frequency and percentage (analyzed by chi-square test with Fisher's exact test).

Results: Female Sexual Function Index (FSFI) total score and all FSFI subscales scores were significantly lower in patients with MS vs healthy control subjects (P < .001); FSFI total scores and all FSFI subscale scores were statistically significantly lower in patients with MS with an International Prostate Symptom Score ≥20 (P < .001) and considering a cutoff for Beck Depression Inventory-II score ≥17, depression was present in 61% (n = 47 of 77) of patients with MS and completely absent in the control group.

Clinical translation: The knowledge that SDs are a common problem in MS and in other chronic illnesses can alleviate the feeling of stigma and talking openly of sexual problems can be helpful for the patients and so the doctor-patient relationship can be reinforced.

Strengths and limitations: The sample was drawn from a single center, and larger multicenter studies that include both genders are needed to obtain strong results.

Conclusion: Our findings confirm the idea of a polygenic and multifactorial etiology of female SDs in MS. Therefore, women with MS should be evaluated in terms of SDs during follow-ups.

Background: Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a new method for treating erectile dysfunction (ED), but there are no standards yet for its indications.

Aim: The study aimed to suggest the early clinical efficacy of Li-ESWT and explore its related factors in young and middle-aged patients with ED who responded to phosphodiesterase type 5 Inhibitors (PDE5Is).

Methods: Data from 61 patients with ED who had previously responded to oral PDE5Is and subsequently underwent Li-ESWT were collected. This included information on age, body mass index, total testicular volume, sex hormones, as well as IIEF-EF scores before treatment and at 1, 3, and 6 months after treatment. The treatment regimen involves a weekly session for four consecutive weeks, with each session administering 5000 shock wave pulses. Linear regression analysis was utilized to identify factors associated with the efficacy of Li-ESWT treatment. Additionally, the improvement in different severity groups of ED before and after treatment, along with their IIEF-EF scores, was compared.

Outcomes: Li-ESWT was more targeted and effective for young and middle-aged patients with erectile dysfunction who responded to PDE5Is.

Results: The age of enrolled patients ranges from 22 to 53 years old, and the IIEF-EF scores at 1 month, 3 months, and 6 months after treatment were compared to baseline for efficacy assessment, showing significant improvements (P < .0001) in all instances. Linear regression analysis using baseline data revealed predictive factors associated with treatment efficacy: treatment efficacy was negatively correlated with baseline IIEF-EF scores (t = -2.599, P = .013) and positively correlated with baseline LH levels (t = 2.170, P = .036).

Clinical implications: Given the considerable cost of Li-ESWT treatment and the emphasis on treatment continuity, we hope to identify the most suitable candidates for Li-ESWT therapy, thereby optimizing its application.

Strengths and limitations: Our findings provide a better solution for nonelderly ED patients who are responsive to PDE5Is. This study was limited by our sample size and follow-up time.

Conclusion: After 3 months of Li-ESWT, the IIEF-EF score gradually stabilizes and short-term maintenance of PDE5Is medication increases the responsiveness to shock wave therapy.

[This corrects the article DOI: 10.1093/sexmed/qfae058.].

Background: The urinary and sexual outcomes after urethroplasty may be a concern for patients, but there are still some controversies regarding the consequences of buccal mucosal graft urethroplasty (BMG) in terms of erectile dysfunction (ED).

Aim: This meta-analysis aimed to compare urinary and sexual outcomes of BMG and end-to-end urethroplasty (EE).

Methods: The PubMed, Web of Science, Cochrane, and Embase databases were searched until February 31, 2023. Data extraction and quality assessment were performed by 2 designated researchers. Dichotomous data were analyzed as odds ratios with 95% confidence intervals (CIs). Heterogeneity across studies was assessed by the I² quantification, and publication bias using Begg's and Egger's tests. Meta-analysis was performed using RevMan software.

Outcomes: Outcomes included stricture recurrence, ED, penile complications, and voiding symptoms.

Results: Eighteen studies, including 1648 participants, were included in our meta-analysis. The meta-analysis revealed that there was no significant difference in stricture recurrence (OR = 0.74; 95% CI, 0.48-1.13; P = .17) and voiding symptoms (OR = 1.12; 95% CI, 0.32-3.88; P = .86) between the BMG group and the EE group. BMG was associated with lower risk of penile complications (OR = 0.40; 95% CI, 0.24-0.69; P = .001) and ED (OR = 0.53, 95% CI, 0.32-0.90, P = .02).

Clinical implications: The study may help clinicians choose procedures that achieve better recovery of the urological and sexual function in the treatment of urethral stricture.

Strengths and limitations: This meta-analysis is the first to evaluate the urinary and sexual outcomes of BMG vs EE. A limitation is that most of the included studies were retrospective cohort studies.

Conclusion: BMG is as effective as EE in the treatment of bulbar urethral stricture, but BMG has fewer complications and ED than EE.

Background: The causal relationship between certain immune cells and erectile dysfunction (ED) is still uncertain.

Aim: The study sought to investigate the causal effect of 731 types of immune cells on ED through Mendelian randomization (MR) using genome-wide association studies (GWAS).

Methods: Genetic instruments for 731 immune cells were identified through GWAS, and ED data were obtained from the FinnGen database. Univariable and multivariable bidirectional MR studies were conducted to explore potential causal relationships between these immune cells and ED. The inverse-variance weighted method was primarily used, with Cochran's Q test and MR-Egger intercept test assessing pleiotropy and heterogeneity. Bayesian weighted Mendelian randomization (BWMR) was also employed.

Outcomes: Six immune cells were identified as related to ED. CD45 on Natural Killer (NK) cells, CD33dim HLA DR+ CD11b + Absolute Count, CD19 on IgD- CD38dim B cells, and CD3 on CD39+ resting CD4 regulatory T cells were identified as risk factors, whereas CD20 on IgD+ CD38dim B cells and Activated & resting CD4 regulatory T cell %CD4+ T cells were protective factors. Further multivariable MR analysis confirmed that 5 of these immune cells independently impacted ED, except for CD45 on NK cells. Reverse MR analysis indicated that ED occurrence decreases certain immune cell counts, but BWMR found no causal relationship for CD20 on IgD+ CD38dim B cells.

Results: Our MR analysis confirmed a potential bidirectional causal relationship between immune cells and ED, providing new insights into potential mechanisms and therapeutic strategies.

Clinical translation: This study provides evidence for the impact of certain immune cells on the development of ED and suggests potential therapeutic targets.

Strengths and limitations: We performed both univariable and multivariable MR to strengthen the causal relationship between exposures and outcomes. However, the population in this study was limited to European ancestry.

Conclusion: Our MR analysis confirmed a potential bidirectional causal relationship between immune cells and ED. This provides new insights into potential mechanisms of pathogenesis and subsequent therapeutic strategies.

Background: Data regarding the effectiveness of low-dose cyproterone acetate (CPA) in testosterone suppression as feminizing hormone therapy (FHT) in individuals assigned male at birth (AMAB) are sparse.

Aim: To assess the effectiveness in testosterone suppression using low-dose CPA (<25 mg/day) compared to standard-dose CPA (25-50 mg/day) in FHT.

Methods: A retrospective cohort study of 59 individuals AMAB using CPA was done at a tertiary care center in Bangkok, Thailand between January 2014 and July 2022.

Outcomes: The main outcomes included a median time when the testosterone was suppressed (<50 ng/dL), the proportion of individuals AMAB who achieved the targeted testosterone level at 3 months, and the testosterone level at each follow-up. Changes in clinical data were assessed.

Results: Among 59 individuals AMAB, 37 initiated CPA with available testosterone levels at the 3-month follow-up. Twenty-two individuals AMAB started with low-dose CPA (12.5 mg/day), and 15 individuals AMAB started with standard-dose CPA. The median time to reach targeted testosterone was 3 months in both groups (adjusted hazard ratio 0.60, P = .489). At 3 months, 72.7% of those on low-dose CPA and 86.7% of those on standard-dose CPA achieved targeted testosterone (adjusted relative risk 0.85, P = .606). Testosterone levels at all follow-up visits were not significantly different. The standard dose group had higher high-density lipoprotein cholesterol (HDL-C) but lower low-density lipoprotein cholesterol (LDL-C) and alanine aminotransferase (ALT).

Clinical translation: This study supports a paradigm shift toward using lower-dose CPA in FHT.

Strengths and limitations: This is one of a few studies showing the effectiveness of low-dose CPA in testosterone suppression within 3 months. Limitations include a small sample size and missing data.

Conclusions: Testosterone suppression is comparable between CPA 12.5 mg/day and the standard dose in FHT.