Background: Assigned males with genital ablation interests may be at higher risk of having erectile dysfunction (ED), especially those who have gone through androgen suppressing pharmacological therapies, orchiectomy and/or penectomy.
Aim: To determine the prevalence and severity of ED in assigned males with castration interests, the types of management strategies they use and what factors are associated with using these strategies.
Methods: We launched an online survey on the Eunuch Archive website to better understand how common ED is, as well as sexual frequencies, and the use of sexual management strategies among assigned males with genital ablation interests.
Outcomes: ED and sexual activity frequencies, preferred role in sexual activities, and previous use of sexual management strategies.
Results: Data from 363 assigned male individuals (50.7 ± 15.6 years old; 23.6% and 3.7% had been orchiectomized and penectomized respectively) showed that 11.2% reported having ED 25-50% of the time, 12.8% had ED 50-75% of the time, and 22.9% had ED 75-100% of the time. Yet a large proportion remained sexually active. For example, 63.5%, 56.2% and 8.8% reported watching porn, masturbating, and having partnered sex several times a week respectively. During partnered sex, 13% of the participants preferred to be in the insertive role, whereas nearly 40% preferred to be in the receptive role. A quarter preferred non-penetrative sex. To maintain sexual activities, commonly used strategies included oral medication (38.8%), vacuum erection devices (25.6%), and strap-on dildo (17.5%). Penile sleeve, penile injection and penile support device were rarely used (<10%).
Clinical implications: Data from our study can be used by clinicians to advise their clients, for example individuals with genital ablation interest who seek to maintain their sexual activities.
Strengths & limitations: Participants completed validated questionnaires. Data were collected online and could not be independently verified.
Conclusions: A strong interest in genital ablation is often associated with a desire to be less sexual. Consistent with that is a high incidence of ED in this population. However, many men with exceptional interests in genital ablation nevertheless remain sexually active and use various strategies to maintain penetrative sex.
Background: While research has shown that sexual dysfunction does not impact fertility, public understanding of this relationship remains unclear.
Aim: To investigate the relationship between public cognition of the association between sexual dysfunction and fertility (ASDF) and the occurrence of sexual dysfunction itself.
Methods: This cross-sectional study utilized a nationally representative sample of 10 761 reproductive-age individuals across China. Participants completed an anonymous questionnaire assessing sexual function and ASDF cognition, using tools like IIEF-5, PEDT, and FSFI-19. Data analysis was conducted with R software, employing χ2 and Mann-Whitney U tests.
Outcomes: The study identified a significant correlation between ASDF cognition and the severity of sexual dysfunction, with lower levels of cognition associated with more severe dysfunction.
Results: Among 10 761 surveyed, 45.08% of men and 54.92% of women showed low ASDF cognition. There was a significant correlation between ASDF cognition and sexual dysfunction severity, with poor cognition associated with more severe ED and PE in men, and sexual intercourse pain in women.
Clinical implications: The findings suggest the need for targeted sexual health education to improve public understanding of sexual dysfunction and its impact on fertility.
Strengths and limitations: Strengths include a large nationally representative sample and the use of validated tools. Limitations are the China-focused sample and subjective assessment tools, which may limit broader applicability.
Conclusion: This study identifies a significant association between ASDF cognition and the severity of sexual dysfunction, underscoring the importance of public education on sexual health.
Background: Despite attempts to assess patient satisfaction with inflatable penile prosthesis (IPP) among Spanish-speaking populations, the absence of a validated, purpose-specific questionnaire in Spanish remains a significant gap.
Aim: This study aims to report the preliminary psychometric validation of Spanish Satisfaction Survey for Inflatable Penile Implant (SSIPI).
Methods: Six centers were selected to represent diverse Spanish-speaking populations in Latin America, the United States, and Spain. It included men who had IPP surgery between 6 months and 5 years ago. The translation and cultural adaptation of the SSIPI from English to Spanish followed a systematic multi-staged approach. Each participant received 4 surveys: (i) the final Spanish SSIPI, (ii) the IIEF erectile function domain (IIEF-EFD), (iii) the Self-Esteem and Relationship (SEAR) questionnaire, and (iv) the International Prostate Symptom Score (IPSS). Reliability, internal consistency, and intraclass correlation were evaluated. A convergent analysis was also used to evaluate Spanish SSIPI with SEAR and IIEF-EFD and a divergent analysis between Spanish SSIPI and IPSS.
Outcomes: Spanish SSIPI psychometric validation.
Results: A total of 111 participants were enrolled in the study. The median age was 64. The majority of participants (87%) were partnered, with a median relationship duration of 96 months. The median partner age was 56. Self-reported median time since IPP implantation was 21 months, with individuals indicating that they use the implant with a median of 5 times per month. Inflatable penile prosthesis satisfaction was generally high across all domains. Spanish SSIPI showed good reliability, high consistency, and high internal reliability across all SSIPI domains. Spanish SSIPI domains had significant correlations with the IIEF-EFD and SEAR. Spanish SSIPI domains were not significantly correlated with the overall IPSS score.
Clinical implications: Spanish SSIPI is a linguistically, culturally, and psychometrically validated patient-reported outcomes measure of satisfaction with IPP, facilitating cross-comparative analysis with previously validated English and French versions.
Strengths and limitations: This study demonstrates several methodological strengths, including applying a comprehensive psychometric approach, validating across multiple centers, and using a solid methodology to validate Spanish SSIPI. However, there are limitations, particularly the underrepresentation of specific subpopulations and the omission of pre-operative erectile function assessment.
Conclusion: The preliminary Spanish SSIPI demonstrated robust reliability and internal consistency across diverse Spanish-speaking regions.
Background: Men who have not engaged in vaginal intercourse in the past 6 months or have never engaged in it often seek help for sexual dysfunction, identifying factors influencing patients' self-assessment of sexual function and the value of masturbation-related parameters in diagnosing sexual dysfunction is of great importance.
Aim: This study aims to understand the reason why patients self-report sexual dysfunction and evaluate the role of masturbation parameters in diagnosing sexual dysfunction in self-reported sexual dysfunction (SRSD) and self-reported no sexual dysfunction (SRNSD) groups.
Methods: Our study was conducted mainly by filling out a questionnaire, which collected demographic information, sexual history as well as sexual parameters. The questionnaire summarized the basis of patients' self-reported sexual dysfunction and also included the Erection Hardness Score (EHS), Masturbation Erection Index (MEI), Masturbatory Premature Ejaculation Diagnostic Tool (MPEDT), and masturbatory ejaculation latency time (MELT).
Outcomes: The main outcomes were reasons for SRSD individuals to judge their sexual dysfunction, the EHS, MEI, MPEDT, and MELT scores.
Results: The most common complaints included insufficient erection hardness and short ejaculation latency time during masturbation, with 84.85% of self-reported erectile dysfunction and 91.80% of self-reported premature ejaculation patients reporting these issues. No significant difference was found between past vaginal sexual experiences (6 months ago) and current self-reported sexual dysfunction. Significant differences were found in EHS, MEI, MPEDT, and MELT scores between the SRSD and SRNSD groups. The MEI showed a sensitivity of 89.29% and a specificity of 81.82%. The MPEDT demonstrated a sensitivity of 98.04% and a specificity of 72.73%.
Clinical implications: We proposed that other than vaginal intercourse, sexual dysfunction should also be assessed from noncoital sex and verified the scientific validity of the masturbation parameters in people without recent vaginal intercourse.
Strengths & limitations: We firstly explored the patients self-perceived basis for sexual dysfunction. However, the objective instruments were not employed in diagnosing sexual dysfunction.
Conclusion: The findings emphasize the importance of a comprehensive clinical assessment that includes evaluating masturbation, noncoital sex (between men and women), morning erections, and past vaginal sexual experiences (6 months ago), moreover, masturbatory scales provide valuable insights in diagnosing sexual dysfunction.
Introduction: Abnormal spontaneous neural activity has been detected in the brain of anejaculation patients. It has been confirmed that anejaculation may be associated with altered regional activation in the brain.
Aim: This study aimed to explore the changes of grey matter in the brain of anejaculation patients.
Methods: Structural magnetic resonance imaging data were collected from 20 primary intravaginal anejaculation (PIAJ) patients and 16 matched healthy controls (HCs). The 3D high resolution T1 weighted images were processed to calculate the grey matter volume and density by the method of voxel-based morphometry analysis.
Outcomes: Differences of grey matter volume and density were compared between groups, and receiver operating characteristic curve was performed to evaluate the values of altered brain regions in distinguishing PIAJ from HCs.
Results: PIAJ patients showed increased grey matter volume in the right supplementary motor area, right inferior temporal gyrus, right superior and inferior occipital gyrus, part of the left precuneus and decreased grey matter grey matter in another part of the left precuneus. In addition, increased grey matter density of the right supplementary motor area, right postcentral gyrus, right inferior temporal gyrus, left middle frontal gyrus, left inferior temporal gyrus and decreased grey matter density of the left precuneus were revealed in PIAJ patients. Both abnormal grey matter volume and altered grey matter density exhibited satisfactory performance in distinguishing PIAJ from HCs.
Clinical implications: These findings suggested that increased microstructural changes of grey matter might be associated with the increased inhibiting effect of the brain on ejaculation.
Strengths & limitations: This study provided new insights into the pathological mechanism underlying PIAJ, These findings are exploratory and that future longitudinal or comparative studies (eg, PIAJ vs. premature ejaculation) will be necessary to clarify whether these changes are predisposing, consequential, or potentially modifiable.
Conclusion: These findings indicated that patients suffering from PIAJ might exhibit abnormal grey matter volume and density in some brain regions, which might be linked to the inability to ejaculate intravaginally. PIAJ patient showed more increased indicators of grey matter when compared with premature ejaculation patients, which often had decreased brain function.
Background: The urgent need for new treatments is driven by the challenging clinical situation of age-related erectile dysfunction (ARED).
Aim: To clarify the conserved molecular mechanisms of ARED across species using multi-omics.
Methods: Rat and mouse models with ARED were developed to facilitate the extraction of mRNA and proteins from the corpus cavernosum for high-throughput sequencing. Bioinformatics techniques were employed to analyze differentially expressed genes and to conduct analyses using the Kyoto Encyclopedia of Genes and Genomes, Gene Ontology, and protein-protein interaction networks. Verification of the results was carried out using immunofluorescence, hematoxylin-eosin staining, and Masson staining.
Outcomes: The multi-omics profiles of ARED rats and mice were analyzed and validated across species.
Results: In both species, Kyoto Encyclopedia of Genes and Genomes and Gene Ontology analyses of transcriptomic and proteomic data revealed that differentially expressed genes were predominantly enriched in pathways associated with alterations in extracellular matrix composition, downregulation of mitochondrial activity, and disruption of protein homeostasis. Immunofluorescence analysis demonstrated an upregulation of reactive oxygen species expression, coupled with a downregulation of Aldh18a1, collagen, and collagen I expression in the corpus cavernosum of mice and rats with ARED.
Clinical implications: To offer a novel approach for enhancing the erectile function in patients with ARED.
Strengths and limitations: The primary strength of this study lies in its utilization of cross-species multi-omics sequencing, which has elucidated the conserved molecular mechanisms underlying ARED. However, a significant limitation is the absence of subsequent validation in patients with ARED.
Conclusions: Cross-species multi-omics comparisons present a potentially innovative approach for elucidating the underlying mechanisms and identifying preventive and therapeutic targets for ARED.
Background: Hyperglycemia induces the development of cavernosa atherosclerosis and fibrosis, and transforming growth factor-β1 (TGF-β1) plays an important role in the induction, promoting fibrosis in corporal tissue, which replaces the normal corpora cavernosa with fibrotic tissue.
Aim: This study explored the role of Angiotensin (1-7) (Ang 1-7) and the regulatory mechanism underlying fibrosis in the corpora cavernosa.
Methods: Primary rat corpus cavernosum smooth muscle cells (CCSMCs) were cultured under normal and high glucose (HG) with or without Ang 1-7. The protein levels of TGF-β1, Collagen I, TGF-β receptor-I (TβRI), and caveolin-1 (Cav-1) were evaluated by western blotting. Reactive oxygen species (ROS) and peroxynitrite (ONOO-) levels in cell culture supernatants were measured by enzyme-linked immunosorbent assay. Intracellular calcium content was determined by flow cytometry.
Outcomes: High glucose significantly increased the protein levels of TGF-β1 and Collagen I, triggered oxidative stress, modulated the AKT signaling pathway, and elevated intracellular calcium ion levels in CCSMCs. Angiotensin (1-7) treatment significantly attenuated HG-induced adverse effects in CCSMCs.
Results: The protective effects of Ang 1-7 against fibrosis in HG-exposed CCSMCs were associated with the downregulation of TGF-β1 levels, accompanied by the attenuation of oxidative stress. The Ang1-7-induced effects in CCSMC cells are mediated through the inhibition of the TGF-β1/AKT signaling pathway.
Clinical translation: Our studies provide new insights into the critical role of the TGF-β1/AKT signaling pathway in CCSMCs, identifying it as a potential therapeutic target for treating patients with erectile dysfunction.
Strengths and limitations: Angiotensin (1-7) is a unique peptide of the renin-angiotensin system with substantial therapeutic potential. This study assessed the therapeutic effect of Ang 1-7 on the fibrotic process and provided new insights for clinical applications. The clinical formulation, drug stability, and in vivo bioactivity of Ang-1-7 remain to be fully investigated.
Conclusion: Angiotensin (1-7) exerts a protective effect on CCSMCs under HG conditions by modulating the TGF-β1/AKT signaling pathway.
[This corrects the article DOI: 10.1093/sexmed/qfaf037.].
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