Sexual Medicine最新文献

Background: Polydioxanone (PDO) thread is a synthetic absorbable surgical suture used for rejuvenation and lifting.

Aim: The aim of this study is to use PDO threads for rejuvenation and enlargement effect in patients with labium majus hypotrophy.

Methods: Twenty-one patients with labia majora hypotrophy were included in the study. Conventionally, surgery, fat filling or hyaluronic acid filling is used for labia majora rejuvenation. In this study, a different technique, the PDO thread suspension technique, was applied. For PDO thread, Hyundae Meditech Co.Ltd's Secret Line Up product containing 50 mm screw thread with 30 G-38 mm needle tip was used. It was planned to use 10 PDO threads for right and left labia majora. After a total of 20 needles were inserted, the needles were removed one by one and the PDO threads remained in the subcutaneous superficial layer and the procedure was terminated 5 min later. Preoperative and postoperative the Female Genital Self-Image Scale (FGSIS) scores of the patients were compared.

Outcomes: The overall FGSIS total score demonstrated a significant increase following the intervention.

Results: The FGSIS total mean score in the preoperative period was increased in the postoperative period. This difference was statistically significant. Moreover, the mean score calculated for each parameter of FGSIS in the preoperative period increased significantly in the postoperative period.

Clinical implications: These findings indicate a favorable safety profile for the use of PDO threads in this clinical context.

Strengths and limitations: The strength of the study is to introduce a minimally invasive and effective method for labia majora lifting, on the other hand, the small number of patients in the study, limitation of the study.

Conclusion: We would like to point out that in this study, we evaluated labium majus rejuvenation from the same perspective, based on the shaping and enlargement of genital appearance and its positive effect on self-confidence and increase in sexual functions. Unlike many labium majus rejuvenation procedures, this less invasive procedure has achieved similar results. In this context, it is a preferable alternative to surgery.

Introduction: Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is associated with poor quality of life. Due to social stigma and its heterogeneous nature, many patients suffer without treatment.

Aims: This case presents the first example of the successful use of a glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide receptor agonist (GLP1/GIP RA) medication for the treatment of PGAD/GPD.

Methods: The patient was identified by the Sexual Medicine Research Team, retained as a patient at a sexual medicine clinic, and interviewed for the purposes of this case report.

Results: This case presents a 44-year-old woman with a lifelong history of PGAD/GPD symptoms that caused extreme distress and depression who experienced 95% resolution of her symptoms within 2 days of starting tirzepatide, a GLP1/GIPRA medication, for weight loss.

Conclusion: Increasing benefits of GLP1/GIPRAs are being uncovered, and further studies must investigate the potential for these medications to be used in patients with PGAD/GPD. This study also provides a potential mechanism for decreased arousal resulting from GLP1/GIP receptor activation in attention/reward pathways in the brain.

Background: During postmenopause, women frequently experience genitourinary symptoms that may result in sexual dysfunctions. Common treatments include hormone replacement therapy or vaginal lubricants. Pelvic floor muscle training (PFMT) has been observed to have beneficial effects on sexual function in other groups of women.

Aim: To evaluate the effect of PFMT on sexual function in postmenopausal women.

Methods: A systematic search was conducted in June 2025, in PubMed, Scopus, Web of Science, Medline, CINAHL databases, and the Google Scholar search engine. Inclusion criteria were randomized clinical trial articles published in English, in which at least one intervention addressed the study objective. A meta-analysis was conducted with a random-effects model.

Results: A total of five studies were selected after applying eligibility criteria. All included articles implemented PFMT interventions, showing improvements in sexual function as assessed by the Female Sexual Function Index. A significant positive effect was shown in the total score of Female Sexual Function Index in experimental group in comparison with control group (P < .001; standard mean difference [SMD] = 1.33; I ² = 92%). A significant positive effect was also demonstrated in orgasm domain (P < .001; SMD = 1.91; I ² = 97%), arousal domain (P < .001; SMD = 1.87; I ² = 96%), and satisfaction domain (P < .001; SMD = 2.16; I ² = 98%). A significant negative effect was found in desire domain (P < .001; SMD = 0.34; I ² = 86%) and lubrication domain (P < .001; SMD = 0.26; I ² = 87%) and finally no significant effects were found in pain domain.

Strengths and limitations: Although this is the first meta-analysis to address this topic in postmenopausal women, the results are heterogeneous and the scientific evidence remains limited.

Conclusion: PFMT appears to have positive effects on sexual function in postmenopausal women, particularly in aspects such as orgasm, arousal, and satisfaction.

Background: Premature ejaculation (PE) is a common male sexual dysfunction with treatment limitations including side effects and partner dependency.

Aim: To evaluate vacuum negative pressure hydropneumatic/pneumatic bubble massage (VNPHP/PBM) efficacy in primary PE (PPE) patients stratified by sexual frequency, focusing on subjective low-frequency (avoidance due to PE) vs objective low-frequency subgroups.

Methods: Retrospective analysis of 42 PPE patients: 22 low-frequency (LF; <4 intercourse/month) including 13 subjective (sub-LF) and 9 objective (ob-LF) vs 20 non-low-frequency (NLF; ≥4/month).

Outcomes: Primary: intravaginal ejaculation latency time (IELT); secondary: Premature Ejaculation Diagnostic Tool (PEDT), Self-Rating Anxiety Scale (SAS) scores, and sexual frequency changes at 4 weeks.

Results: Both groups showed significant improvements in IELT, PEDT, and SAS scores (P < .05). Low-frequency group showed greater improvements than NLF in PEDT reduction (6.36 ± 2.38 vs 7.90 ± 2.02, P = .03), SAS reduction (30.95 ± 9.57 vs 38.45 ± 8.85, P = .01), and sexual frequency increase (0.50 [0.00, 4.00] vs 1.00 [1.00, 2.00], P = .02). Crucially, sub-LF patients exhibited dramatic sexual frequency normalization (6.00 [4.00, 7.50] vs 2.00 [1.00, 2.00], P < .001), while ob-LF unchanged (P = .56). No adverse events.

Clinical implications: Vacuum negative pressure hydropneumatic/pneumatic bubble massage is a partner-independent therapy that not only improves ejaculatory control but also restores sexual activity in patients avoiding intercourse due to PE-related anxiety.

Strengths and limitations: Strengths: First study analyzing subjective vs objective low-frequency PE, standardized protocols. Limitations: Retrospective design, self-reported IELT data, lack of a control group, and the non-blinded nature of the study.

Conclusion: Vacuum negative pressure hydropneumatic/pneumatic bubble massage significantly improves PE symptoms with amplified benefits in low-frequency patients, particularly those with PE-driven sexual avoidance.

Background: Chronic stress can not only lead to depression-like behavior but also sexual dysfunction. Morinda officinalis oligosaccharides (MOO) is a formula of traditional Chinese medicine commonly used in invigorating the kidney and strengthening Yang, and relieving depression.

Aim: This study was designed to explore the effects and mechanisms of MOO in treating chronic stress-induced depression as well as sexual dysfunction.

Methods: The sucrose preference test, forced swimming test (FST) and novelty-suppressed feeding test (NSFT) were carried out to evaluate the depression status. Sexual behavior was tested on all mice, then the extent of damage to the testicles and epididymis was assessed by H&E staining; Serum sex hormone and neurotransmitters were assessed in the plasma by Enzyme-Linked Immunosorbent Assay. The testicular tissues were applied with the kit for the detection of antioxidant-related indexes and reproductive-related hormones.

Outcomes: The study evaluates the effects of MOO on depression-like behaviors and sexual function levels in CUMS-induced mice by analyzing the behavioral tests, histopathological staining of testis and epididymis, sex hormones, antioxidant capacity, neurotransmitter levels, and sexual behavior abilities of mice in each group.

Results: CUMS led to mice depression and plasma neurotransmitter levels decreased. Accompanying sexual dysfunction in depressed mice was also manifested in many aspects. Compared with the control group, the capture latency and mount latency of male mice in model group were significantly prolonged. HE showed that testicular and epididymal tissues of mice in the CUMS group were severely vacuolated. Testicular marker enzymes, antioxidant indexes and sex hormones were disorganized. The sperm concentration and viability in the epididymis of the mice in model group were significantly reduced. It was suggested that MOO could improve the damage caused by CUMS, and improve the sperm quality of the model mice.

Clinical translation: MOO are promising to be translated into a potential therapeutic drug for clinically improving chronic stress-related depression and sexual dysfunction.

Strengths and limitations: Multi-dimensional verification confirms that MOO can effectively alleviate depressive states and sexual dysfunction in CUMS-induced mice. Future studies should explore the in-depth mechanisms underlying its antidepressant and anti-sexual dysfunction effects based on relevant signaling pathways.

Conclusion: These results suggest that MOO can regulate sexual dysfunction and play a protective role in neurodevelopment during CUMS by regulating sex hormones.

Background: Emerging evidence suggests that insulin sensitivity plays a role in testosterone regulation. The estimated glucose disposal rate (eGDR) is a validated metabolic marker reflecting insulin resistance (IR). However, the relationship between eGDR and testosterone levels in adult men remains unclear.

Aim: This study aimed to examine the association between eGDR, total testosterone (TT) levels, and testosterone deficiency (TD) risk.

Methods: Data from the 2013-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed. Weighted multivariable linear and logistic regression models were used to evaluate the association between eGDR, TT levels, and TD risk (TT <300 ng/dL). A smoothing spline curve fitting approach was applied to assess the shape of the relationship. Subgroup analyses and interaction tests were conducted to explore potential effect modifications. Receiver operating characteristic (ROC) analysis was performed to assess the predictive ability of eGDR for TD.

Outcomes: eGDR was calculated using waist circumference (WC), hypertension (HTN), and glycated hemoglobin (HbA1c).

Results: A total of 4087 male participants were included in the final analysis. After adjusting for all covariates, higher eGDR was significantly associated with increased TT levels (β = 31.83, 95% CI, 22.13-41.54, P < .001) and a lower risk of TD (OR = 0.68, 95% CI, 0.58-0.80, P = .002). Quartile analysis showed that participants in the highest eGDR quartile (Q4) had significantly higher TT levels than those in Q1 (β = 147.27, 95% CI, 66.99-227.55, P = .02) and a markedly reduced TD risk (OR = 0.20, 95% CI, 0.06-0.70, P = .03). Smoothing spline curve fitting approach confirmed a linear relationship between eGDR and TT levels, as well as an inverse association with TD risk. A significant interaction was observed for diabetes status (P for interaction = .001), indicating a potential modifying effect. ROC analysis demonstrated that eGDR had moderate predictive ability for TD (AUC = 0.6839, 95% CI, 0.6659-0.7019).

Clinical implications: eGDR may serve as a useful metabolic marker for identifying individuals at risk of TD.

Strengths and limitations: GDR may serve as a valuable metabolic marker for identifying individuals at risk of TD; due to its cross-sectional design, we cannot establish causality between eGDR and testosterone levels.

Conclusion: These findings suggest that eGDR is associated with testosterone levels and TD risk in adult men, highlighting the potential metabolic link between insulin sensitivity and testosterone regulation.

Background: Infertility can adversely affect both sexual function and psychological well-being in women. Although physical activity is widely known to benefit overall health, its specific influence on the sexual and mental health of infertile women has not been clearly established.

Aim: This study aimed to evaluate the associations between physical exercise frequency, sexual function, and psychological health in sexually active women with infertility.

Methods: A total of 728 infertile women were enrolled from a reproductive medicine center between 2021 and 2024. Participants were stratified into four groups according to self-reported exercise frequency. Sexual function was assessed using the Female Sexual Function Index (FSFI), anxiety with the Generalized Anxiety Disorder-7, depression with the Patient Health Questionnaire-9, and marital satisfaction with the Quality of Marriage Index. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were conducted.

Outcomes: The primary outcomes were the FSFI total and domain scores assessing sexual function, along with Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scores reflecting psychological well-being.

Results: Women who engaged in regular physical activity (≥once a week) had significantly higher FSFI scores than those who did not exercise. However, after adjusting for confounding variables, multivariable logistic regression showed that exercise frequency was not an independent predictor of sexual dysfunction. Significant predictors included longer infertility duration (odds ratio = 1.46, P < .01), lower frequency of sexual activity (odds ratio = 1.12, P = .03), and psychological distress index (odds ratio = 2.27, P < .01).

Clinical implications: Lifestyle modifications such as physical activity may support mental and relational well-being, but targeted psychological support is crucial for managing sexual dysfunction in infertile women.

Strengths and limitations: Strengths of the study include a large sample size and validated multidimensional assessments. Limitations include its cross-sectional design and reliance on self-reported measures.

Conclusion: While regular physical activity is associated with better sexual and psychological health in infertile women, it is not an independent predictor of sexual function. Psychological distress, infertility duration, and sexual activity frequency are key determinants, emphasizing the need for integrated biopsychosocial care.

Background: Among causes of male sexual dysfunction, the prevalence of delayed ejaculation (DE) is lower than that of premature ejaculation or erectile dysfunction (ED), and its epidemiology remains poorly characterized, particularly in Asian populations.

Aim: To estimate DE prevalence and identify associated factors of DE in a nationwide sample of Japanese men.

Methods: A cross-sectional, internet-based survey conducted by the Clinical Research Promotion Committee of the Japanese Society for Sexual Medicine between May 29 and June 24, 2023, targeted Japanese men aged 20-79 years through a general population panel. Among 6228 valid responses, 5331 men who reported sexual activity were included in the analysis. DE-related distress was used to define the condition. Data on demographics, medical comorbidities, lifestyle factors, and sexual function were collected. Participants were also asked whether they desired treatment for DE and whether they had consulted a physician regarding this condition. Associated factors were identified through multivariate logistic regression analysis.

Outcomes: Prevalence of DE, associated demographic and clinical factors, treatment-seeking desire, and actual help-seeking behavior among sexually active Japanese men.

Results: The prevalence of DE was 5.16%. Of the affected individuals, 58.18% desired treatment, but only 11.88% actually sought it. Multivariate analysis revealed that psychotropic drug use (odds ratio [OR] = 2.41), pelvic trauma (OR = 2.39), low partnership satisfaction (OR = 2.27), ED (OR = 2.04), neurological diseases (OR = 2.02), obesity (OR = 1.51), high frequency of masturbation (OR = 1.24), and high frequency of sexual intercourse (OR = 1.17) were significantly associated with DE (all P < .05). Conversely, having children showed an independent association with a lower likelihood of DE (OR = 0.57, P < .001).

Clinical implications: These findings highlight that DE is associated with multiple psychological, sexual, and physical health factors and that treatment-seeking behavior remains low despite substantial distress.

Strengths and limitations: This large, nationwide epidemiological study on DE in Japan is the first with a robust sample size and multivariate analysis. However, the reliance on self-reported data and internet-based sampling may introduce reporting bias and limit generalizability.

Conclusion: DE affects approximately 5% of sexually active Japanese men and shares many risk factors with ED. Although more than half of those with DE desire treatment, only a minority seek care. Greater clinical awareness and patient education are warranted.

Background: Despite the significance of penile dimensions in male health and self-perception, there is a lack of population-specific references and understanding of self-assessment biases.

Aim: To establish population-specific references and investigate self-assessment biases in penile dimensions.

Methods: A single-center cross-sectional study (2024-2025) prospectively enrolled 342 Chinese males. Standardized measurements of flaccid and stretched lengths were performed by a trained andrologist. Participants were asked to report their perceived erect penile length, and stratified into three mutually exclusive groups: (1) accurate estimation (AE), where self-reported lengths = stretched lengths; (2) overestimation (OE), where self-reports > stretched lengths; and (3) underestimation (UE), where self-reports < stretched lengths. The penile lengthening ratio (PLR) was calculated as (stretched - flaccid length)/flaccid length. Statistical analyses included paired t tests and one-way analysis of variance for multigroup comparisons.

Outcomes: Mean flaccid and stretched lengths, self-reported lengths, and the distribution of estimation groups were determined.

Results: Mean flaccid and stretched penile lengths were 7.27 ± 1.60 and 11.89 ± 1.57 cm, respectively. Self-reported erectile lengths (12.81 ± 1.85 cm) significantly exceeded measured values (Δ = 0.92 cm, P < .001), with 72.81% of the participants overestimating their erectile length. OE participants exhibited greater flaccid (7.46 ± 1.64 vs 6.74 ± 1.39 cm, P < .05) and stretched lengths (12.01 ± 1.47 vs 11.46 ± 1.69 cm, P < .05) than AE participants. UE individuals showed paradoxically higher stretched lengths (13.50 ± 2.38 vs 11.46 ± 1.69 cm, P < .05) and PLR (97 ± 36% vs 71 ± 14%, P < .05).

Clinical implications: These findings provide critical references for clinical counseling on penile size and perioperative doctor-patient communication, potentially alleviating patient anxiety stemming from cognitive biases to a certain extent.

Strengths and limitations: The strengths include standardized measurements and a clear classification of estimation group. The limitations include incomplete baseline data (lacking penile circumference, smoking history, etc.), single-center small-sample bias, inevitable selection bias, and absence of partner satisfaction data and validated assessments.

Conclusion: This study revealed that self-reported erect lengths among adult males were significantly longer than clinician-measured stretched lengths. OE participants accounted for more than 70% of the sample, while UE participants tended to have a greater PLR. The research provides reference ranges for flaccid and stretched penile lengths in Chinese males, offering objective data to support cli

Background: Sexual dysfunctions (SDs) due to gynecological cancer (GC) are common. Healthcare providers (HCPs) are often not prepared to address sexual health issues, missing the opportunity to provide comprehensive post-cancer survivorship care.

Aim: To review the available evidence about diagnosing and managing SD after GC and providing practical clinical suggestions on behalf of the European Society of Sexual Medicine.

Methods: A systematic literature search was performed on Pubmed and Medline for the relevant literature from January 1980 until June 2024.

Outcomes: Recommendations were provided according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria, focusing on clinical practice.

Results: The main areas covered include the impact of diagnosis and treatment of GC (surgery, chemotherapy, immunotherapy, and radiotherapy) on sexual health; the process of screening, counseling, and referral; medical and psychological management of SD; issues related to special populations, ie, sexual minorities and previvors.

Clinical implications: Addressing aspects of sexual health is important in patients with GC during diagnosis, treatment, and post-cancer care. Diagnosis and treatment of SDs should follow the recommendations in non-cancer patients, but specific aspects linked to cancer and its treatment should be kept in mind.

Strengths and limitations: All studies have been evaluated by a panel of experts who provide comprehensive, evidence-based recommendations for clinical practice.

Conclusion: HCPs should feel comfortable addressing sexual health topics in patients with GCs due to the abundance of available data. Appropriate sexological interventions can improve the quality of life for patients and their partners.