Sexual Medicine最新文献

Introduction: In the field of sexual health research, anxiety stands out as a pivotal element recognized by both researchers and clinicians for its potential to disrupt multiple phases of the sexual response cycle. While research on anxiety and sexual dysfunctions has typically focused on studying various manifestations of anxiety separately, clinical practice often reveals a different reality, with patients frequently experiencing multiple types of anxiety simultaneously.

Aims: The objectives of this paper are to provide a comprehensive understanding of the diverse manifestations of sex-related anxiety and their clinical implications, and to identify and highlight existing scientific gaps that require further investigation.

Methods: This statement paper is an expert opinion-based proposal developed under the auspices of the European Society for Sexual Medicine (ESSM). A group of experts designed a conceptual framework on anxiety related to sexual dysfunctions and reviewed the literature from 2005 to 2023 across various databases focusing on five anxiety domains, sexual performance anxiety, sexual phobia, sexual distress, attachment anxiety, and somatic symptom disorder, leading to consensus on position statements. The process included revisions approved by the ESSM Executive Committee and affiliate societies.

Results: Eighteen statements on anxiety in individuals with sexual dysfunctions were developed, including three general statements on anxiety, three on sexual performance anxiety, three on sexual phobias, three on sexual distress, three on attachment anxiety, and three on somatic symptom disorder. Each type of anxiety was further described in terms of its prevalence, assessment, covariates and consequences, intervention strategies, and future directions for research.

Conclusion: Clinicians addressing sexual dysfunctions should screen for signs of various types of anxiety and assess their interference with sexual situations, overall sexual life, and broader life functioning. The literature suggests specific treatment approaches for different anxiety manifestations, emphasizing the need for tailored interventions. Treatments should be carefully selected based on the type of anxiety identified.

Background: Men who have sex with men (MSM) represent a high-incidence population with HIV, while HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are among the most effective interventions to prevent HIV transmission and save lives.

Aim: This study aims to analyze the awareness, use, and acceptability of HIV PrEP and PEP among MSM to inform optimized implementation strategies for this population.

Methods: A non-government organization based questionnaire survey was used to collect data from July 2022 to December 2023. A total of 1065 MSM were incorporated into our analysis with the following information: socio-demographics, awareness, use, and acceptability of HIV PrEP and PEP. Binary logistic regression analysis was employed to determine the factors on seeking, use, and acceptability of PrEP and PEP.

Outcomes: Despite high awareness of PrEP/PEP, actual adoption remained limited among MSM.

Results: The average age of the participants was 28.48 ± 7.33. About 89.7% of the participants were aware of PrEP and 94.4% were aware of PEP. About 7.9% of the participants have used PrEP and 11.6% have used PEP. About 87.9% of the participants had willingness to use PrEP and 90.2% had willingness to use PEP. The main ways for the participants to get PrEP and PEP were through Internet hospitals, followed by local hospitals, and recommendations from acquaintances. The most concerned factors were preventive effect followed by side effects of PrEP and PEP. Doubts about the preventive effect of PrEP and PEP significantly affect their seeking, use, and acceptability (P < .05).

Clinical translation: This study provides insights for enhancing the implementation of HIV PrEP and PEP among MSM.

Strengths and limitations: This study is the first to depict the situation of awareness, use, and acceptability of HIV PrEP and PEP among MSM in China. Limitations involve social desirability bias and reliance on self-reported diagnosis.

Conclusion: Accelerating PrEP/PEP scale-up requires enhanced risk perception, expanded service access, and comprehensive sensitization programs.

Background: The recent efforts to increase the proportion of women in urology have demonstrated success; it is equally important to evaluate success of these efforts in urologic sub-specialized fields as well.

Aim: This study aims to evaluate the impact of these efforts and the representation of women urologists in the sexual medicine literature.

Methods: Original research manuscripts from three prominent sexual medicine journals from 2013 to 2023 were collected. Manuscripts submitted under Paraphilia subsections, as well as systematic reviews, meta-analyses, communications, commentaries, replies, and those involving psychometrics were excluded. Proportion of women authors in these journals' literature was determined by searching names of first and last authors on the Internet.

Outcomes: This study evaluates whether authorship by women in sexual medicine literature has increased following recent efforts to enhance their representation in urology and related fields.

Results: 1065 of 2701 (39%) collected manuscripts meeting criteria were from first (FA) or last authors (LA). Women were significantly less likely to be FA or LAs across these manuscripts (P< 0.001).Further, variables such as author degree, field, profession, and institution type all demonstrated significant gender disparities in FA and LA as well. Representation of women FAs and LAs was lowest in urology (15%, 5%) compared to obstetrics and gynecology (64%, 55%) and psychology (68%, 63%).

Clinical implications: These disparities in sexual medicine publications have important consequences for women urologists; these opportunities often impact future career advancement in academia.

Strengths and limitations: Gender identification relied on traditional markers (such as names and pronouns), which may not fully capture the diversity of gender identities, we sought to mediate that by using a binary identification method. The analysis was also limited to first and last authorship, which may not capture contributions from middle authors.

Conclusion: Although the push to increase the proportion of women urologists has shown success, there are still significant disparities seen in publication of sexual medicine literature. Potential avenues for improvement include mentorship and targeted institutional support.

Background: Optical techniques, including laser Doppler flowmetry (LDF), photoplethysmography (PPG), and near-infrared spectroscopy (NIRS), are emerging as one of the most popular tools for female sexual arousal response (FSAR) assessment. However, to our knowledge, no narrative reviews have focused on the application of these optical techniques in FSAR assessment.

Aim: To fill out the existing gap, we review the literature regarding using optical techniques in FSAR assessment in preclinical and clinical studies.

Methods: A literature search was performed on the manuscript with terms including "female sexual dysfunction, FSAR, LDF, PPG, NIRS" between 1974 and 2024 using PubMed, Google Scholar, and MEDLINE. Among the articles identified, 18 articles were reviewed after excluding articles with non-relevant topics, duplicate articles, and articles not written in English.

Outcomes: This article reviews 11 studies that used LDF/imaging, four studies that used PPG, and three studies that used NIRS, including the employed experimental protocols in each study.

Results: Various optical techniques were used in FSAR assessment during electrical stimulation, visual and tactile stimulation, and drug administration. Additional studies, including using non-human primate models, testing the effects of different anesthetics on FSAR in preclinical studies, and performing more clinical studies to develop a standard for human FSAR monitoring using optical techniques that can lead to the use of optical techniques in clinical practices, could be considered. Meanwhile, non-contact systems and other optical techniques like optical coherence tomography, photoacoustic endoscopy, and Raman spectroscopy can be developed for future FSAR studies.

Clinical translation: This article can provide a good overview of the preclinical and clinical investigations of FSAR using LDF, PPG, and NIRS. Understanding the differences between the techniques will allow clinicians to choose an appropriate technique for their FSAR studies.

Strengths and limitations: This review is the first to overview various optical techniques used to evaluate FSAR. A limitation of the review is that there is no clinical study that uses NIRS for FSAR monitoring.

Conclusions: LDF/imaging, PPG, and NIRS have been used in various FSAR investigations. Such optical techniques have the potential to be used in future FSAR studies to quantitatively analyze the physiological changes during FSAR.

Background: Sexual self-care behaviors in women play a crucial role in promoting their sexual health, ultimately enhancing family and societal well-being. Adequate knowledge and the ability to apply such information are key factors influencing sexual self-care.

Aim: This study was conducted to examine the relationship between sexual health literacy and sexual self-care among women.

Methods: This cross-sectional study was conducted among 435 women of reproductive age attending healthcare centers affiliated with Iranshahr University of Medical Sciences, Iran, during 2024-2025. Data were collected using validated questionnaires on sexual self-care and the Iranian Adult Sexual Health Literacy scale. Statistical analysis was performed using SPSS 22, employing logistic regression, analysis of variance (ANOVA), and multiple linear regression models.

Outcomes: Determined the relationship between sexual health literacy and sexual self-care in young women.

Results: The results revealed a statistically significant direct association between sexual self-care and sexual health literacy (P = .000). Women demonstrating higher sexual health literacy scores reported higher sexual self-care scores. Sexual self-care was associated with total sexual health literacy scores, as well as with the dimensions of information access skills and information application skills.

Clinical implications: The results provide a rationale for policymakers to implement targeted sexual health literacy programs, which can subsequently enhance self-care practices.

Strengths and limitations: The strengths of this study include the use of robust statistical methods and a large, representative sample size. However, limitations should be noted, such as the dependence on self-reported data, which may introduce bias, and the restricted generalizability of findings due to the single-region, cross-sectional study design.

Conclusion: This study demonstrated that improved sexual health literacy enhances sexual self-care scores in women. These results highlight the crucial need to enhance women's sexual health literacy.

Background: Personality traits are the intrinsic factors of mental health, and may play a role in the pathogenesis of premature ejaculation (PE), but few studies have evaluated the association between personality traits and the 4 types of PE.

Aim: We aim to investigate the personality traits associated with PE in 4 types of PE and their associations with PE.

Methods: Between February 2024 and February 2025, we conducted a survey in Anhui, China, and enrolled 1708 males. Personality traits were independently assessed by the Myers-Briggs Type Indicator (MBTI). The index of PE was used to evaluate ejaculation control, sexual life satisfaction, and distress caused by PE.

Outcomes: Energy-Introversion, Perceiving-Sensing, Judging-Feeling, and Orientation-Perception may influence men's sexual activity, and the Energy, Perceiving, and Orientation have different effects on the 4 types of PE.

Results: The ISFP personality type is most common in those with PE. Among the 4 subtypes of PE, the Introversion-Intuition-Feeling-Perceiving (INFP) personality type is most common in those with Lifelong PE (LPE), the Extraversion-Sensing-Feeling-Judging (ESFJ) personality type is most common in those with Acquired PE (APE), the Introversion-Sensing-Feeling-Perceiving (ISFP) personality type is most common in those with Variable PE (VPE), and the Extraversion-Sensing-Feeling-Perceiving (ESFP) personality type is most common in those with Subjective PE (SPE).

Clinical implications: Personality trait factors may influence the pathogenesis of PE, and the use of the MBTI personality assessment provides a new perspective on how personality traits play a role in the onset of PE.

Strengths & limitations: It is necessary to conduct larger-scale, more rigorous community-based studies to further elucidate the role of personality traits in the development of PE.

Conclusion: Men with traits of Introversion, Sensing, Feeling, and Perception tend to have high sensitivity, introspection, and a deep pursuit of idealized relationships.

Background: Although increasingly recognized, research into the prevalence and co-occurrence of binge eating disorder (BED) and compulsive sexual behavior disorder (CSBD) remains scarce.

Aim: To evaluate the prevalence and co-occurrence of BED and CSBD in a representative Polish population while examining their associations with sexual behavior-related variables, and levels of anxiety and depression.

Methods: Data were collected from a representative sample of Polish adults, consisting of 1527 participants aged 18-65.

Outcomes: The occurrence and intersection of symptoms of BED and CSBD.

Results: Men reported significantly higher CSBD symptoms (Z = 9.62, P < .001, d = 0.52) and problematic sexual behaviors, while women reported higher BED (Z = 5.51, P < .001, d = 0.30) and anxiety symptoms (Z = 7.46, P < .001, d = 0.39). BED and CSBD symptoms co-occurred significantly in men (χ ²(1) = 59.00, P < .001), but not in women (χ ²(1) = 1.51, P = .22). BED symptoms were positively correlated with anxiety (r = 0.46, P < .001) and depression (r = 0.47, P < .001), highlighting their interplay with psychological distress.

Clinical implications: Findings underscore shared mechanisms across BED and CSBD, suggesting the potential effectiveness of transdiagnostic treatment approaches addressing co-occurring symptoms, emotional regulation, and impulsivity within a unified therapeutic framework.

Strengths and limitations: Strengths include a representative sample and the examination of underexplored comorbidity patterns. Limitations include the cross-sectional design and reliance on self-report measures, warranting longitudinal and multimethod research for causal inferences.

Conclusion: This study reveals significant gender differences in BED and CSBD symptoms and demonstrates their co-occurrence among men, emphasizing the need for gender-sensitive, integrated clinical approaches to assessment and treatment.

Background: Sexual dysfunction is a common and distressing consequence of prostate cancer (PCa) treatment, yet few healthcare institutions offer comprehensive, systematic care, limiting equitable access. Virtual models may improve accessibility and efficiency without sacrificing effectiveness.

Aim: To assess whether outcomes in the virtual Sexual Health and Rehabilitation eClinic (SHAReClinic) were comparable to those in the in-person Prostate Cancer Rehabilitation Clinic (PCRC) in improving sexual health outcomes for PCa survivors.

Methods: A retrospective cohort chart review was conducted on PCa patients enrolled in either the PCRC or SHAReClinic between September 2017 and August 2018, with data collected 12 months post-treatment. Clinic assignment was based on standard care pathways. Sexual health outcomes were measured using the Sexual Health Inventory for Men (SHIM), Sexual Distress Scale (SDS), Male Sexual Health Questionnaire (MSIS), and Expanded Prostate Cancer Index Composite (EPIC-26). Pro-erectile medication usage was also analyzed.

Outcomes: Primary outcomes were SHIM and SDS scores. Secondary outcomes included MSIS, EPIC-26 scores, and pro-erectile medication use as an indicator for adherence and ongoing sexual activity.

Results: Among 98 PCa patients (55 PCRC, 43 SHAReClinic), no significant differences were found in SHIM and SDS scores. While partnered PCRC participants reported significantly higher intimacy on the MSIS compared to partnered SHAReClinic participants (P = .042), no significant differences were found on the EPIC-26 sexual health domain. Pro-erectile medication use was similar in both groups. Multivariable analyses showed comparable outcomes in sexual function, distress, and health-related quality of life, except for intimacy.

Clinical implications: SHAReClinic yields comparable outcomes to PCRC and provides an effective, resource-efficient alternative to in-person sexual rehabilitation for PCa patients, particularly in settings with limited accessibility or resources.

Strengths and limitations: This study provides a comprehensive assessment of sexual health outcomes; however, the small sample size limits generalizability. In addition, there was a significant imbalance in treatment modality, with radiation patients represented only in the SHAReClinic cohort. Further research in larger, more diverse populations with longer follow-up is needed to confirm these findings and better understand intimacy differences.

Conclusion: SHAReClinic demonstrates outcomes comparable to PCRC in managing sexual dysfunction in PCa patients, offering a viable and accessible option for sexual rehabilitation.