Sexual Medicine最新文献

Background: In Asian countries, discussing sex-related issues remains a taboo. Sexual dysfunction is not even considered a serious disorder in Pakistan.

Aim: To explore sexual dysfunction and marital satisfaction within the Pakistani context to develop supportive intervention programs.

Methods: This study entailed a mixed method approach and was carried out in Karachi, Pakistan. The sample comprised 28 married men, and data were gathered by in-depth interviews. Subsequently, data were analyzed through content analysis.

Outcomes: There is a strong relationship between marital dissatisfaction and sexual dysfunction in adult married males aged 25 to 40 years in Pakistan.

Results: The analysis of participants' perspectives revealed 5 themes: psychosocial issues, rationale of openness in marital life, insufficient sexual knowledge, lack of sexual health service, and individual consequences.

Clinical implications: The results of this study suggest that it is an important suggestion to the government of Pakistan to introduce sexual health counseling and premarital counseling programs at the university level. The Ministry of Health and Higher Education needs to promote awareness about sexual health, sexual dysfunctions, and marital satisfaction, which will enable men to understand their sexual problems and effectively cope with them.

Strengths and limitations: The results of this study highlight the biopsychosocial dimensions of human sexuality. In this context, the psychosocial aspects associated with sexual dysfunctions are influenced by cultural and societal norms, where open discussions about sexual issues between male and female partners may be limited due to concerns about maintaining harmony in marital relationships. The limitation of this study is that the sample is not generalized; it is also not a demographic representation of all socioeconomic groups in Pakistan. Participants in low and middle classes reported an inability to seek help from professionals due to the high costs of treatments. Therefore, the results cannot to be extended to all Pakistani males.

Conclusion: In this study, male sexual dysfunction strongly affects marital satisfaction within the couple. As such, marital counseling and psychotherapeutic strategies play an important role to help individuals and couples manage their sexual dysfunctions and enhance their marital satisfaction.

Background: Peyronie's disease (PD) is a fibrotic disorder affecting the penile tunica albugínea, with unclear pathophysiology despite centuries of recognition.

Aim: This scoping review maps the effects of interventions in basic PD research, synthesizing evidence from in vivo and in vitro studies to guide future investigation.

Methods: In October-November 2023, a systematic search was conducted across PubMed, Embase (Ovid), Science of Web, and Scopus, following SRYCLE's guidelines. Relevant studies were screened for data on interventions targeting PD in vivo and in vitro, with no language or time restrictions.

Outcomes: Primary outcomes included changes in extracellular matrix (ECM) proteins, myofibroblast activity, and plaque size.

Results: Of 683 articles screened, 40 studies were included. Key interventions such as phosphodiesterase inhibitors and stem cell therapies reduced ECM proteins and myofibroblast activity, particularly in early-stage PD models. However, none of the studies adhered to the ARRIVE guidelines, highlighting a gap in reporting standards.

Clinical translation: Findings suggest potential benefits of early and multimodal treatment strategies, but further human trials are needed to bridge the gap in clinical practice.

Strengths and limitations: This review systematically synthesizes animal and cellular research on PD, highlighting significant preclinical findings. However, the lack of standardized reporting and limited human studies restricts direct clinical applicability.

Conclusion: Further research should prioritize adherence to reporting standards, optimize treatment timing, and explore combination therapies to advance PD management.

Background: While premature ejaculation (PE) can be divided into lifelong PE (LPE), acquired PE, natural variable PE (NPE), and subjective PE (SPE), there is no objective method to classify PE.

Aim: To determine the value of serum serotonin (5-HT), leptin, and norepinephrine (NE) levels in the classification of PE.

Methods: From July 2023 to July 2024, we recruited 150 participants and divided them into 4 groups: LPE (43 cases), NPE (32 cases), SPE (35 cases), and non-PE (40 cases) groups. All participants' baseline data, premature ejaculation diagnostic tool score, and intravaginal ejaculation latency time were investigated. In addition, all participants' serum 5-HT, leptin, and NE levels were measured.

Outcome: Serum 5-HT, NE, and leptin levels were compared among all groups.

Results: Serum 5-HT levels were lower and NE and leptin levels were higher in the LPE group compared to the SPE, NPE, and non-PE groups (P < .05). However, serum 5-HT, leptin, and NE levels were not significantly different among the non-PE, NPE, and SPE groups (P < .05). In addition, serum 5-HT <95.0 ng/mL, NE >543.0 ng/L, and leptin >19.8 ng/mL may be predictive indicators of LPE.

Clinical significance: Based on serum 5-HT, NE, and leptin levels, LPE can be distinguished from SPE and NPE, which provides an objective basis for the treatment of PE.

Strengths and limitations: There is no effective method to classify PE. The main limitation of this study is the limited sample size.

Conclusion: The serum 5-HT, leptin, and NE levels in PE patients may contribute to the classification of PE.

Background: Both serum testosterone (T) levels and erectile dysfunction (ED) are associated with systemic diseases in men and ED is the most common presenting symptom of hypogonadism.

Aim: To evaluate the association of serum total testosterone (TT) levels with cardiometabolic diseases in men with ED.

Methods: Serum endogenous TT levels were determined to evaluate their associations with cardiometabolic diseases in men with ED in outpatient clinics. Participants were divided into hypogonadal with TT < 350 ng/dL (12.1 nmol/L) and eugonadal groups, as well as into four equal quartiles based on TT levels. The Framingham risk score was used to estimate individual 10-year coronary heart disease (CHD) risk.

Main outcome measures: Cardiometabolic factors included obesity, diabetes mellitus (DM), hypertension (HT), dyslipidemia, and the Framingham risk score.

Results: From 2010 to 2021, a total of 4467 subjects with ED were consecutively recruited for this study, and 3909 subjects' (87.5%) data with a mean age of 53.0 ± 12.9 (20.0-88.0) years had data eligible for analysis. Testosterone levels declined with age and a higher body mass index (BMI) was associated with lower T levels across all age groups (P < .001). Compared to the eugonadal group, the hypogonadal group was older and had a higher BMI and more cardiometabolic diseases (all P < .01). In multivariate analysis, odds ratio (OR) for hypogonadism was highest in men with obesity (2.51), followed by age group of ≥70 years (2.32), DM (1.59), HT (1.41), and dyslipidemia (1.26). Compared with the lowest TT quartile, higher quartiles of TT had significantly lower risk for cardiometabolic diseases (all P < .001). Among men over 50 yrs, hypogonadal men had a higher 10-year CHD risk than eugonadal men as predicted by the Framingham risk score (P < .001).

Clinical implications: Our results highlight the value of determining TT levels in men with ED because of their association with cardiometabolic diseases and the potential benefits of T therapy for improving men's health.

Strengths and limitations: Strengths of this study include a relatively large sample and detailed medical history collection. Limitations included a small portion of subjects with repeat TT tests, and the lack of data on free T and bioavailable T levels, and single-site recruitment.

Conclusions: TT levels are independently associated with cardiometabolic diseases including obesity, DM, HT, and dyslipidemia, and indicate a higher risk for CHD in men with ED. Measuring TT levels in men with ED presents an opportunity to improve overall health and reduce CV risk.

Background: Increasing evidence suggests that a diet rich in antioxidants may prevent erectile dysfunction (ED), but the impact of comprehensive dietary antioxidants on ED has been little studied.

Aim: To investigate the association between the composite dietary antioxidant index (CDAI) and ED risk in adult men.

Methods: The study performed a cross-sectional analysis using data from the 2001-2004 National Health and Nutrition Examination Survey to investigate the association between the composite dietary antioxidant index (CDAI) and ED. The connection between the CDAI and ED was assessed using univariate and multivariate weighted logistic regression models, as well as the restricted cubic spline.

Outcomes: Association between the CDAI and the prevalence of ED.

Results: The study included a total of 3699 participants, among whom 1042 were diagnosed with ED, resulting in a prevalence of 28.17%. Multivariate weighted logistic regression consistently showed a negative association between the CDAI and ED (OR = 0.95, 95% CI: 0.92-0.98, P = .005). The group with the highest CDAI (Q4) had a 33% reduced risk of ED than the group with the lowest CDAI (Q1) when the CDAI was regarded as a categorical variable (OR = 0.67, 95% CI: 0.49-0.91, P = .014). Restricted cubic spline analysis showed that the CDAI was linearly related to the risk of ED (non-linearity P = .652). Furthermore, subgroup analysis indicated that the inverse relationship between CDAI and ED was more pronounced in individuals under 60 years of age, those with diabetes, and those without hypertension.

Clinical implications: Dietary strategies to increase antioxidant intake might offer a potential approach to reducing ED risk and supporting men's sexual health.

Strengths and limitations: This is a large-scale study investigating the association between the CDAI and ED. However, as a cross-sectional study, the timeliness of the dataset and the recall bias inherent in dietary data somewhat limit the reliability of the results.

Conclusion: This study identified a significant inverse association between the CDAI and ED risk among adult men in the United States; however, as a cross-sectional study, this research cannot establish causation, and further longitudinal studies are needed to validate these findings and provide more definitive evidence.

Background: Currently, the treatment and prevention of erectile dysfunction (ED) remain highly challenging.

Aim: This study conducted a systematic druggable genome-wide Mendelian randomization (MR) analysis to identify potential therapeutic targets for ED.

Methods: A proteome-wide MR approach was employed to investigate the causal effects of plasma proteins on ED. Subsequently, summary data-based MR (SMR) analysis was performed to identify potential drug targets for ED. Enrichment analysis and protein-protein interaction (PPI) networks revealed the functional characteristics and biological relevance of these potential therapeutic targets. Drug prediction and molecular docking studies were conducted to validate the pharmacological activity of these identified targets. Finally, a systematic MR analysis was conducted to assess upstream intervention factors, such as lifestyles and diseases, associated with these targets, providing insights for the prevention and treatment of ED.

Outcomes: This study identified several potential therapeutic targets for ED.

Results: Proteome-wide MR analysis revealed that 126 genetically predicted plasma proteins were causally associated with ED. SMR analysis indicated that TMEM9 was associated with an increased risk of ED, while MDH1, NQO1, QDPR, ARL4D, TAGLN2, and PPP1R14A were associated with a decreased risk of ED. These potential targets were primarily enriched in metabolic and redox-related biological processes. Molecular docking indicated that the predicted drugs had favorable binding affinities with the proteins, further confirming the pharmacological value of these targets. Finally, 6 plasma proteins (MDH1, NQO1, QDPR, ARL4D, TAGLN2, and TMEM9) could be modulated by lifestyle- and disease-related factors.

Clinical implications: This study provides new insights into the etiology and potential drug targets of ED and contributes to the development of more effective treatments for ED and reducing the cost of drug development.

Strengths and limitations: This is a systematic and extensive study exploring the causal relationship between plasma proteins and ED, which helps to provide a comprehensive perspective to understand the role of potential targets in ED. However, we did not conduct this study in different types of ED or different stages of ED progression.

Conclusion: In summary, this study identified 7 plasma proteins causally associated with ED and provided new insights into the etiology and potential drug targets for ED.

Background: Diabetic erectile dysfunction (DMED) has a high incidence and is poorly treated.

Aim: This study investigates fibrosis's genetic profiling and explores potential mechanisms for DMED.

Methods: The DMED model was constructed in rats using streptozotocin. Erectile function was quantified using cavernous nerve electrostimulation. Fibrosis was evaluated using Masson's staining. RNA-seq was employed to analyze differentially expressed genes and fibrosis-related genes (FRGs) were acquired. Function enrichment analyses were performed, and genetic interaction was analyzed. Hub FRGs were screened using machine learning algorithms and Cytoscape tools and validated in Gene Expression Omnibus databases. Moreover, biological roles and subpopulation distribution of hub FRGs were determined.

Outcomes: Fibrosis-related genetic functions may play a vital role in DMED.

Results: Based on comprehensive analysis, 45 differentially expressed FRGs were identified. These genes participate in regulating smooth muscle cell proliferation, vasoconstriction, and collagen-associated activities. Final analyses identified and validated a core gene signature comprising TIMP1, BMP7, and POSTN. They were closely associated with diabetic complications-related signaling pathways and extracellular matrix-receptor interaction.

Clinical translation: The identified fibrosis-related gene signature may serve as the novel biomarkers for treating DMED.

Strengths and limitations: The study is the first to investigate the genetic profiles behind fibrosis and DMED using comprehensive approaches. However, the validation is not adequate and more animal experiments are needed.

Conclusion: The gene profiling and biological functions of FRGs in DMED were identified. These results broaden the understanding of fibrosis in DMED.

Background: The International Index of Erectile Function (IIEF) stands out for its utility and widespread use to measure sexual function in men. However, it lacks consistency in its internal latent structure across studies, has not been evaluated for measurement invariance, and has not undergone psychometric validation for its 15-item form in Spanish among South American countries.

Aim: To examine the IIEF's psychometric evidence (ie, structural/criterion validity and reliability) in a sample of adult men and determine its measurement invariance across relationship status (single vs in a relationship) and age generations (generations Z, Y/millennials, and X).

Methods: A sample of 650 sexually active males was derived from a broader Chilean study (Chilean Sex and Sexuality Study). We used a confirmatory factor analysis to determine the IIEF's structural validity, sexual satisfaction dimensions to establish its criterion-related validity, and Cronbach alpha and McDonald omega to assess the reliability of its scores.

Outcomes: Measures of goodness of fit.

Results: The evidence supported the 5-factor latent solution. Meanwhile, criterion-related validity revealed subtle yet significant differences in sexual satisfaction, with younger men displaying higher satisfaction in various sexual domains. In contrast, middle-aged men and those in a relationship showed better sexual function. Finally, the IIEF was invariant across age groups and relationship status at the factor covariance level.

Clinical translation: This study provides evidence that the IIEF is a valid, reliable, and invariant tool for the clinical practice in men's sexual health, particularly that associated with their sexual function and dysfunction.

Strengths and limitations: The study included a comprehensive validity analysis of the IIEF's psychometric properties, demonstrating its reliability and validity across diverse Chilean male subpopulations. The study also offered the IIEF's first assessment of measurement invariance and confirmed its suitability for clinical and research use in the Chilean population. Meanwhile, the study's limitations include a lack of clinical population and a sample predominantly younger, cisgender, and heterosexual.

Conclusion: Our study provides evidence of the IIEF's 5-factor structure and measurement invariance across age generations and relationship status in Chilean men, supporting its validity for clinical use and research and broadening its applicability in global sexual health studies, particularly in the Spanish-speaking South American male population.