Sexual Medicine最新文献

Background: Sexual dysfunction (SD) due to Selective Serotonin Reuptake Inhibitors (SSRI) use is a common condition encountered by psychiatrists and its etiology has not been fully elucidated.

Aim: To determine the relationship between alpha Melanocyte Stimulating Hormone (α-MSH) and Melanocortin-4 receptor (MCR4) levels and sexual function levels of patients with and without SSRI related SD and control group and to examine whether α-MSH and MCR4 play a role in the etiology of SSRI related SD.

Methods: A total of 92 patients and 49 healthy volunteers who applied to psychiatry outpatient clinic were included in the study. Sociodemographic form, sexual history form, Structured Clinical Interview for DSM 5, Psychotropic Related Sexual Dysfunction-Turkish version (PreSexDQ-T), Arizona Sexual Experiences Scale, Beck Depression and Anxiety Inventory were used in the evaluation interview with the referred patients. Patient groups were formed according to whether there was SSRI related SD according to the sexual history and PreSexDQ-T scale.

Outcomes: The α-MSH and MCR4 levels were significantly lower in patients with SD due to SSRI use.

Results: α-MSH and MCR4 levels were lower in the SSRI related SD (SSRI-SD (+)) group than in the not experiencing SD with SSRIs (SSRI-SD (-)) and control groups. The mean α-MSH and MCR4 value of the control group was found to be significantly higher than the SSRI-SD (+) patient group, the mean MCR4 value of the control group was found to be significantly higher than the mean MCR4 value of the SSRI-SD (-) patient group. The mean MCR4 and a-MSH values of the SSRI-SD(+) group using SSRI with fluoxetine were significantly lower than the SSRI-SD (-) group using SSRI with fluoxetine.

Clinical implications: There is a role for α-MSH and MCR4 in SSRI related SD.

Strengths and limitations: Its strength is that it is the first human study in this field. Limitations include small sample size and unknown baseline levels of α-MSH and MCR4.

Conclusion: The fact that α-MSH and MCR4 play a role in the etiology of SD due to SSRI use in woman and that there was a significant difference between SSRI-SD (+) and SSRI-SD (-) groups when α-MSH and MCR4 levels were compared in fluoxetine users supports the hypothesis that serotonin may mediate SD via α-MSH and MCR4 through 5-hydroxytryptamine-2C (5-HT_2C) antagonism.

Introduction: Clitoral priapism is persistent clitoral engorgement without sexual stimulation. Presentation is sparse, and therefore limited treatment options have been investigated.

Aim: We present a case report of a 34-year-old female presenting with persistent nonischemic clitoral priapism 5 years after aggressive clitoral stimulation.

Methods: Patient underwent six weekly Li-ESWT sessions at frequency 4 Hz, energy 0.11 mJ for 2000 shocks per session. Assessment included physical examination of clitoral glans engorgement and retraction, global response assessment (GRA) score, need for topical phenylephrine, and ability to achieve orgasm.

Results: At the end of the therapy, examination revealed complete resolution of priapism with a normal-appearing clitoris fully retracted behind the clitoral hood. The patient reported no longer requiring topical phenylephrine, a significant improvement in GRA, and the ability to achieve orgasm.

Conclusion: We present a case of nonischemic clitoral priapism resolved with Li-ESWT. More investigation regarding the utilization of Li-ESWT in the treatment of clitoral priapism is highly encouraged.

Background: Individuals from all over the world are increasingly using the internet to purchase sex toys and gadgets to enhance their sexual experience and provide variety and excitement to their sexual encounters.

Aim: This study examined the trends about the most popular preferred sex toys by nation/region from 2009 using data from Google Trends (GT).

Methods: GT was used to generate a "line-graph" that displays how interest in a topic in certain places has risen or diminished over time. Search terms were generated for vibrator, dildo, anal plug, strap-on, and masturbator. The data were included "globally" from January 1, 2009 to June 30, 2023.

Outcomes: The search values for certain terms were indexed using the relative search volume (RSV), which is shown on a scale of 0-100.

Results: In the linear regression analysis, the trends by strength were sorted as follows: dildo, vibrator, strap-on, anal plug, and masturbator. In 2018, vibrator surpassed strap-on and came in second, while the regression analysis showed a positive trend for dildo between 2009 and 2016 (P = .014). It had a negative trend after 2016. Strap-on was the only one to have a downward trend (P = .029). Regression analysis revealed positive trends for vibrator and masturbator (P = .030, P = .045). The upward trends have continued uninterruptedly since 2009.

Clinical implications: According to our research, interest in online trends relating to sex toys has increased along with advancements in technology and clinical applications. This rise is linked to the worldwide sex toy industry's development in response to consumer demand and ease of accessibility.

Strengths and limitations: This is the first research of this sort, looking into the interests of internet users about sex toys by country over time using GT. GT data is anonymous, and analysis of subpopulation groups is not possible.

Conclusion: Individual preferences for sex toys have different trends on different continents around the world. The compatibility of sex toys with technology over time, their clinical use, and sex toy-related injuries play an important role in the selection process. Web trends seem appropriate to reflect how the demand for sex toys has changed over time.

Background: Women's experiences of the expulsion of fluids during sexual stimulation, commonly referred to as female ejaculation/squirting, are not well comprehended in the existing literature.

Aim: To investigate women's knowledge about and experiences of female ejaculation/squirting.

Methods: Data from 1568 women (aged 18 to 69) were collected using a cross-sectional online-based questionnaire (in Swedish).

Outcomes: The study focused on descriptive features of knowledge about, reactions to, occurrence of, and sensations around female ejaculation/squirting.

Results: Among the participants, 58% had experienced ejaculation/squirting (significantly more often among non-heterosexuals). Among women without such experience, only one-third would like it to happen. Among women with such experience, ejaculation/squirting occurred consistently during sexual practice for a small percentage (7%) and on a few occasions for about half (52%). Despite most (77%) rating it as primarily a positive sensation, many reacted with shock/shame (28%) or thought they had urinated (26%) the first time it occurred. Many (61%) reported orgasm occurring close to, or simultaneously, with ejaculation/squirting, and these women were more likely to report it as a positive sensation (P < .001). Despite overall positive aspects, 58% had wanted to avoid it at some point, mainly because it got too wet or due to insecurities about the content of the fluid. Having wanted to avoid it at some point was more likely among those who sensed the fluid as being expelled from the urethra (P < .001) or whose partner reacted negatively to it (P < .001).

Clinical translation: This study contributes with a nuanced understanding of women's experiences of ejaculation/squirting and related challenges.

Strengths and limitations: This study is the first to explore women's desire for ejaculation/squirting, their initial reactions, and reasons for avoidance. There are limitations due to the nature of the data collection, such as missing data and potential overrepresentation of women who are informed and open-minded about ejaculation/squirting.

Conclusion: Ejaculation/squirting is a common occurrence among women and, despite being perceived predominantly positively, particularly when linked with an orgasm, initial reactions, and avoidance underscore complexities related to excessive wetness and insecurities about the fluid's content.

Background: A study of topical Sildenafil Cream 3.6% was completed among healthy premenopausal women with female sexual arousal disorder.

Aims: To compare efficacy endpoints based on product use in pre-planned and post-hoc subsets of age, race, and medication use.

Methods: Phase 2b, exploratory, randomized, placebo-controlled, double-blind study of Sildenafil Cream, 3.6% among healthy premenopausal women with female sexual arousal disorder (FSAD). Eligible participants were randomized 1:1 to Sildenafil versus Placebo Cream and used investigational product for 12 weeks.

Outcomes: The co-primary efficacy endpoints were the change from baseline, at week 12, in the Arousal Sensation (AS) domain of the Sexual Function Questionnaire (SFQ28) and Question 14 (Q14) of the Female Sexual Distress Scale - Desire, Arousal, Orgasm (FSDS-DAO). The secondary efficacy endpoint was the change from baseline at week 12 in the mean number of satisfactory sexual events (SSEs) reported in a daily diary. Exploratory efficacy endpoints included the Desire and Orgasm domains of the SFQ28.

Results: Age group (≥18 years and ≤ 45 years versus >45 years), race group (White versus non-White), and baseline use/non-use of hormonal contraception did not significantly affect the co-primary endpoints of the SFQ28 AS domain and FSDS-DAO Q14 (P values >0.11). Non-White Sildenafil Cream users had an increase in SSEs at week 12 (0.7 ± 0.63) while non-white Placebo Cream users reported a decrease (-1.5 ± 0.58) (P = .02). Daily psychiatric medication use among women assigned to either Placebo or Sildenafil Cream resulted in lower SFQ28 Desire domain scores compared to non-users of these medications. Women who used study product only in un-partnered events had a larger improvement in their SFQ28 Orgasm domain scores at week 12 (2.39 ± 0.95) with Sildenafil Cream use compared to Placebo (-0.19 ± 0.75) (P = .06). Non-White women represented a higher proportion of un-partnered women and women who used IP only during un-partnered sexual events compared to White women (P < .01).

Clinical implications: These pre-planned subset analyses will help refine target populations in future studies of Sildenafil Cream, 3.6% for the treatment of FSAD.

Strengths and limitations: Subset analyses focused on variables pertinent to future target populations. The current study population was primarily educated non-Hispanic White women.

Conclusion: Age and hormonal contraceptive use did not impact the efficacy of topical Sildenafil Cream. Daily psychiatric medication use decreased sexual desire in active and placebo users.

Background: Increased access to and indications for genetic testing will lead to more women undergoing risk-reducing salpingo-oophorectomy (RRSO), with a potential impact on sexual function.

Aim: Our objective was to prospectively investigate (1) sexual function in women with pathogenic variant (PV) in BRCA1/2 genes, before and 1 year after RRSO, and to compare with a healthy age-matched control group and (2) to study if testosterone levels correlate with sexual functioning after RRSO.

Methods: A prospective observational follow-up study of 43 BRCA1/2-PV carriers planned for RRSO and 73 healthy-age matched controls. Data including personal medical history, the Female Sexual Function Index (FSFI) and blood samples for analysis of testosterone by tandem mass spectrometry and free androgen index (FAI) were collected before and 1 year after surgery or at inclusion (controls).

Outcomes: Sexual function and testosterone levels following RRSO.

Results: Median age in the RRSO group was 42 years at baseline, 55.8% were premenopausal and 53.5% had a history of breast cancer. The RRSO group had significantly lower median FSFI total score (P < .001), lower scores of all 6 FSFI domains (P < .001), as well as a higher proportion of female sexual dysfunction (FSD) (P < .001) compared to the control group at 1 year after surgery. In the RRSO group, users of menopausal hormone therapy (MHT) had a significantly higher median FSFI total score compared with the nonusers both at baseline (P = .023) and follow-up (P = .010). The proportion of FSD was significantly higher in the non-MHT group at both baseline (P = .041) and follow-up (P = .009). FAI was significantly lower in the RRSO group when compared to the controls at 1-year follow-up (P = .041); however, no significant correlations between testosterone levels and FSFI scores were found.

Clinical implications: The results highlight the need to counsel BRCA1/2-PV carriers before RRSO and offer a structured follow-up and support addressing sexual function and impact of MHT use.

Strengths and limitations: The main strength of this study is its prospective design with age-matched controls. Limitation is a small sample size.

Conclusion: Our findings show that sexual function deteriorated 1 year after RRSO independent of testosterone levels, and the proportion with impaired sexual function was higher compared to healthy age-matched controls.

Background: Premature ejaculation (PE), affecting approximate 5%, has an unclear pathogenesis, limited treatment efficacy, and a lack of effective diagnostic methods.

Aim: This prospective diagnostic study aimed to compare segmental dorsal penile nerve somatosensory evoked potentials (DNSEP) differences among patients with acquired premature ejaculation (APE), primary premature ejaculation (PPE), and healthy controls.

Method: This prospective diagnostic study examined patients suffering from PE who visited the outpatient clinic of the Department of Urology of the Second Affiliated Hospital of Zhejiang University School of Medicine from January 1, 2022 to February 28, 2023. According to the definition of PE by the ISSM, 16 cases comprised the healthy control group, 31 in the APE group, and 28 in the PPE group. Each group was examined based on the segmental DNSEP with electrodes recording at multiple locations (the selected location was at the Cz and the C7). The latency time of the evoked potential obtained at Cz was P40, and that obtained at C7 was P30. The P30/P40 ratios of P40, P30, and DNSEP wave amplitudes at C7 and Cz were compared among the 3 groups of patients.

Result: No group differences were found in P40 latency at Cz. However, PPE showed higher DNSEP amplitude at Cz, while APE showed lower amplitudes compared with controls. Both APE and PPE had significantly shorter P30 latency at C7 than controls. SEP amplitude at C7 was similar in APE and PPE but lower than in controls. The P30/P40 ratio was lower in APE compared with PPE and controls.

Clinical implications: Segmental SEP may offer more assistance in localizing neurological lesions, potentially guiding clinical treatment.

Strengths and limitations: In this study, the innovative use of the P30/P40 ratio was proposed, maintaining consistency in emotional states and measurement conditions for the same patient. However, limitations include a restricted number of patient cases and challenges in obtaining a diverse control group, potentially introducing bias. In addition, not considering subclinical premature ejaculation and the comorbidity of PE + ED (LCEE) in patient stratification is another limitation of this study. Results suggest a correlation between secondary PE and underlying conditions, such as obesity and lumbar spine injuries. The study validates multi-site somatosensory-evoked potential examination for locating neural lesions but acknowledges the need for future invasive needle electrode AEP testing to analyze neuropathological changes more comprehensively.

Conclusion: In conclusion, segmental DNSEP examination aids in localizing neuropathy in APE patients, and the P30/P40 ratio proves more accurate in diagnosing APE than P40 alone.

[This corrects the article DOI: 10.1093/sexmed/qfae061.].