Sexual Medicine最新文献

Background: Premature ejaculation (PE) is linked with abnormal brain activity that is modifiable by electroacupuncture (EA).

Aim: In this study we aimed to explore the central pathological mechanism underlying EA in treating PE.

Methods: Six-week-old male Sprague-Dawley rats were divided into a PE group (n = 8) and a control group (n = 8) according to ejaculatory frequency during copulatory behavior. All rats underwent EA at the Zusanli acupoint (ST-36) for 4 weeks. Magnetic resonance imaging data were collected before and after EA.

Outcomes: The behavioral parameters, plasma norepinephrine levels, fractional amplitude of low frequency fluctuation (fALFF), and regional homogeneity (ReHo) were evaluated.

Results: The PE group ejaculated more times with shorter latency compared with controls. After EA, the ejaculation frequency of the PE group decreased, and the ejaculation latency period increased, with no changes observed in the control group. Norepinephrine levels were higher in the PE group than in the controls and were positively correlated with ejaculation frequency and negatively correlated with ejaculation latency. The PE group showed lower fALFF in the right striatum and higher ReHo in the brainstem compared with controls. After EA, controls showed decreased fALFF in the right striatum, left olfactory bulb, and dorsal fornix and increased ReHo in the right interpeduncular nucleus, as well as decreased ReHo in the left striatum, prelimbic system, right basal forebrain region, septal region, and olfactory bulb, while the model group exhibited increased fALFF in the right hypothalamic region, decreased fALFF in the left globus pallidum and right basal forebrain region and increased ReHo in the right interpeduncular nucleus, as well as decreased ReHo in the left striatum, olfactory bulb, basal forebrain region, dentate gyrus, right dysgranular insular cortex, and striatum. Compared with the controls after EA, the model group showed increased ReHo of the right hypothalamic region and decreased ReHo of the right dysgranular insular cortex.

Clinical implications: These findings might enhance the understanding of PE and contribute to new, targeted therapies for PE.

Strengths and limitations: The therapeutic effects might be achieved by EA inhibiting the activity in brain regions involved in ejaculatory behavior. However, the curative effect of acupuncture might be underestimated due to some curative effects of sham acupuncture used in the control group.

Conclusion: In conclusion, the ejaculatory frequency of rats may be reduced and ejaculation latency could be extended by EA at ST-36, which might be achieved by the effects of this treatment on brain activity.

Background: Gender-affirming bilateral orchiectomy (GABO) may be completed as either a standalone procedure (sGABO) or at the same time as gender-affirming vaginoplasty (vGABO). GABO is postulated to decrease gender-affirming hormone therapy (GAHT) dosages and reduce gender dysphoria, but these phenomena are not empirically described in the medical literature.

Aim: The primary aim of this study was to describe changes in GAHT dosages after sGABO and vGABO. A secondary aim was to assess sGABO patients' preoperative decision-making priorities and postoperative satisfaction.

Methods: A retrospective chart review identified 204 patients who completed GABO as either a standalone procedure (64% of patients) or at the same time as vaginoplasty (36%). Patient demographic data, surgical outcomes, and pre- and postoperative GAHT dosage data were recorded. Patients completed an opinion questionnaire to assessed decision-making priorities, as well as postoperative satisfaction and changes in quality-of-life measures.

Outcomes: Primary outcomes included pre- and postoperative dosages of estradiol, progesterone, and spironolactone. Secondary outcomes included sGABO patient priorities, satisfaction with sGABO, changes in quality-of-life measures between sGABO and vGABO patients, and sGABO recommendations to future patients.

Results: The sGABO and vGABO patients experienced a statistically significant dosage reduction in all three GAHT assessed: estradiol, progesterone, and spironolactone (P < .05). All patients discontinued spironolactone postoperatively. Zero complications related to GABO were recorded for patients in either group. The patient questionnaire revealed that sGABO patients prioritize decreasing endogenous testosterone and reducing their GAHT as most important in their decision to undergo sGABO prior to vaginoplasty. A majority of sGABO patients reported improvement in all nine quality-of-life indices. None of the sGABO patients would recommend against sGABO to a friend who is waiting for vaginoplasty.

Clinical implications: For patients who are interested in vaginoplasty, sGABO may serve as a more immediate, low-risk, intermediary step that comes with the benefits of GABO, including significant GAHT medication reduction and gender dysphoria relief.

Strengths and limitations: This study offers a comprehensive evaluation of the impact of GABO on patients, combining empirical data with subjective patient feedback. Limitations include the retrospective design and the use of unvalidated survey questions.

Conclusion: Prevaginoplasty GABO is a viable option to more immediately alleviate gender dysphoria and reduce GAHT medications for patients who are interested in gender-affirming vaginoplasty.

Background: Erectile dysfunction (ED) in patients receiving methadone maintenance treatment (MMT) is a relatively neglected issue.

Aim: In this study we sought to determine the actual prevalence of ED and risky sexual behaviors in patients receiving MMT and identify clinically relevant risk factors for ED, particularly mental health conditions, that may contribute to achieving holistic healthcare and improving treatment adherence in this patient population.

Methods: A cross-sectional study of male Chinese MMT patients was conducted. Comprehensive demographic and clinical data regarding age, obesity, history of major mental and physical illness, HIV infection, other substance use, methadone dose/duration, and associated risky sexual behaviors were all collected. Assessment tools, including the 5-item International Index of Erectile Function, the Chinese Health Questionnaire, and the Taiwanese Depression Questionnaire were administered.

Outcomes: The relationship between mental health-related factors and ED was fully analyzed and elaborated.

Results: The prevalence of ED among male patients in a methadone maintenance therapy outpatient clinic was 55.7%. The prevalence rate of ED among the individuals treated for longer than 6 months was 56.8%, whereas that for untreated individuals was 52.0%. Additionally, methadone-treated individuals were older and had a higher proportion of condom use and drug-assisted sexual activity than untreated individuals. Pearson correlation revealed that higher Chinese Health Questionnaire and Taiwanese Depression Questionnaire scores were negatively correlated with lower scores on the 5-item International Index of Erectile Function. In the multivariate regression model, anxiety and other psychosomatic symptoms were associated with more severe ED, whereas individuals who consumed alcohol within the past month had less severe ED after adjustment for other demographic and clinical variables. The findings of the present study revealed no association between ED and methadone treatment duration or dosage.

Clinical implications: Healthcare professionals should discuss mental health issues in patients on MMT with ED, especially anxiety symptoms and recent alcohol use.

Strengths and limitations: This study is one of the few reports within the limited body of research highlighting a significant association of ED with anxiety-related symptoms in patients undergoing MMT. Our study had some limitations. First, the sample size of HIV-infected individuals was insufficient. Second, the cross-sectional study design could not definitively demonstrate a causal mechanism.

Conclusion: In patients undergoing MMT, individuals who reported less severe anxiety symptoms and alcohol consumption in the past month tended to have less severe ED, regardless of the MMT dura

Background: Observational studies indicated that serum uric acid (SUA) was associated with male sexual hormones and erectile dysfunction (ED). However, their relationship was still heterogeneous.

Aim: This study conducted 2-sample univariate mendelian randomization (UVMR) and multivariate mendelian randomization (MVMR) to explore the causal relationship between SUA and sexual hormones as well as ED.

Methods: Genetic variants associated with SUA were derived from the UK Biobank database (N = 437 354). Outcomes from the IEU Open GWAS and summary data sets were sexual hormones (sex hormone-binding globulin [SHBG], testosterone, estradiol [E2], follicle-stimulating hormone, luteinizing hormone) and ED, with 3301 to 625 650 participants. UVMR analysis primarily utilized the inverse variance weighted method, complemented by MVMR analysis. Thorough sensitivity analyses were carried out to ensure the reliability of results. Moreover, mediation analysis was conducted to estimate the mediated effect between SUA and outcomes.

Outcomes: The primary outcomes included results of UVMR and MVMR analysis and mediation analysis, along with sensitivity analyses involving the Cochran Q test, the MR Egger intercept test, leave-1-out analysis, and the MR-PRESSO method (mendelian randomization pleiotropy residual sum and outlier).

Results: UVMR analysis revealed that an elevated SUA level could decrease levels of SHBG (β = -0.10, P = 1.70 × 10^-7) and testosterone (β = -0.10, P = 5.94 × 10^-3) and had a positive causal effect on ED (odds ratio, 1.10; P = .018). According to reverse mendelian randomization results, increased levels of SHBG (β = -0.06, P = 4.82 × 10^-4) and E2 (β = -0.04, P = .037) could also reduce SUA levels. As shown by MVMR analysis, SUA had a negative effect on SHBG and testosterone levels (P < .05), while the significant causal relationship between SUA and ED disappeared. Furthermore, SHBG mediated 98.1% of the effect of SUA on testosterone levels. Results of other mendelian randomization analyses were not statistically significant. No pleiotropy was found by sensitivity analysis in this study.

Clinical implications: Given the causal relationship between SUA and sexual hormones, we must focus on SUA and E2 levels in men, especially patients with hypogonadism and ED.

Strengths and limitations: This study evaluated the causal effect of SUA on male sexual hormones and ED genetically for the first time, clarifying the common biases in observational studies and confirming the negative relationship between SUA and testosterone level. Limitations include a population based on European ancestry, some crossover of the samples, and unobserved confounding factors.

Conclusion: Genetic studies provide evid

Background: The 6-item Female Sexual Function Index (FSFI-6) is the shortened version of the widely used 19-item FSFI-19, designed for efficient screening of female sexual dysfunction in outpatient settings. However, this shorter FSFI-6 tool has not yet been validated for use in Bangladesh.

Aim: The purpose of this study was to culturally adapt and validate the FSFI-6 in Bangla.

Methods: The FSFI-6 was translated into Bangla using standard adaptation protocols. We interviewed 100 married, sexually active women aged 18 years and over from the outpatient and psychiatric sex clinic of a psychiatry department. Of these women, 50 were clinically diagnosed with sexual disorders based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, criteria. After obtaining written informed consent, participants completed a semi-structured questionnaire to provide sociodemographic information and the Bangla-adapted version of the FSFI-6. We assessed reliability and construct validity using the Statistical Package for Social Sciences, version 25, along with Classical and Bayesian Instrument Development software.

Outcome: Study outcomes were internal consistency, factor structure, and sensitivity and specificity.

Results: The study involved 100 participants with a mean ± SD age of 30 ± 5.4 years, ranging from 18 to 48 years. The majority of respondents (54.34%) reported issues related to sexual desire. The overall mean score on the Bangla-adapted FSFI-6 was 18.4 ± 5.4. Reliability analysis showed a high internal consistency, with a Cronbach's alpha of 0.887 indicating robust reliability. Both inter-item correlations and item-total correlations were within the acceptable range. A cutoff value of 19 for the FSFI-6 demonstrated high discriminative power, effectively distinguishing between individuals with sexual disorders and those without sexual disorders or with other psychiatric conditions. The sensitivity at this cutoff was 96%, with a specificity of 100%.

Clinical implications: The FSFI-6 Bangla version can be used to screen patients for female sexual dysfunction in an outpatient setting.

Strengths and limitations: The internal consistency of this study, indicated by a Cronbach's alpha of 0.887, was robust. The instrument is time efficient, user friendly, and well suited for outpatient settings. However, the sampling technique utilized was nonrandomized, confined to a single institution, and did not incorporate assessments for concurrent validity or test-retest reliability.

Conclusion: The FSFI-6 Bangla version showed good reliability and validity in this study, supporting its usability as a valuable tool for screening sexual dysfunction in female.

Background: Negative genital self-image is associated with sexual unresponsiveness and dysfunction.

Aim: This study aims to determine the relationship between men's genital self-image and premature ejaculation, with identifying influencing factors.

Methods: The research is designed as a descriptive and correlational study. The sample consists of 188 men aged 18 to 60 years who volunteered to participate in the study.

Outcomes: A negative correlation was observed between genital self-image and premature ejaculation (P < .05).

Results: The average age of the participating men was 39.5 ± 9.79 years (mean ± SD), with 91.5% being married. The average age of the participants' first sexual encounter was 20.43 ± 4.01 years, and 38.3% reported experiencing premature ejaculation. The mean score for the Male Genital Self-image Scale was 21.10 ± 5.59, and that for the Premature Ejaculation Diagnostic Tool was 6.96 ± 3.73. As a result of the study, it was revealed that participants who experienced premature ejaculation were not at peace with their bodies and were dissatisfied with their sexual experiences and their genital size and function, with significantly lower levels of genital self-image (P < .05).

Clinical implications: Identifying factors that affect men's genital self-image is crucial for maintaining sexual functions.

Strengths and limitations: In Turkey, sexuality is a taboo subject, often considered shameful and rarely discussed, making it challenging to find participants willing to engage in research.

Conclusion: Men's genital self-image influences the characteristics of premature ejaculation.

Background: Research demonstrates significant gender- and sexual orientation-based differences in orgasm rates from sexual intercourse; however, this "orgasm gap" has not been studied with respect to age.

Aim: The study sought to examine age-related disparities in orgasm rates from sexual intercourse by gender and sexual orientation.

Methods: A survey sample of 24 752 adults from the United States, ranging in age from 18 to 100 years. Data were collected across 8 cross-sectional surveys between 2015 and 2023.

Outcomes: Participants reported their average rate of orgasm during sexual intercourse, from 0% to 100%.

Results: Orgasm rate was associated with age but with minimal effect size. In all age groups, men reported higher rates of orgasm than did women. Men's orgasm rates ranged from 70% to 85%, while women's ranged from 46% to 58%. Men reported orgasm rates between 22% and 30% higher than women's rates. Sexual orientation impacted orgasm rates by gender but not uniformly across age groups.

Clinical translation: The persistence of the orgasm gap across ages necessitates a tailored approach in clinical practice and education, focusing on inclusive sexual health discussions, addressing the unique challenges of sexual minorities and aging, and emphasizing mutual satisfaction to promote sexual well-being for all.

Strengths and limitations: This study is the first to examine the orgasm gap with respect to age, and does so in a large, diverse sample. Findings are limited by methodology, including single-item assessments of orgasm and a sample of single adults.

Conclusion: This study revealed enduring disparities in orgasm rates from sexual intercourse, likely resulting from many factors, including sociocultural norms and inadequate sex education.

Background: Cardiovascular diseases (CVDs) and erectile dysfunction (ED) frequently co-occur, significantly affecting the quality of life of individuals.

Aim: To assess the impact of cardiac rehabilitation (CR) on ED in patients with CVD through a systematic review and meta-analysis.

Methods: This study analyzed randomized controlled trials and other studies comparing CR with usual care for adult males (≥18 years) with any cardiac disease. Literature searches were extensive, and the risk of bias was evaluated by the Cochrane Collaboration tool. Data from 6 studies involving 668 participants were included in the meta-analysis.

Outcomes: The primary outcome was the improvement in ED, as measured with the International Index of Erectile Function.

Results: A statistically significant improvement in erectile function was observed across 6 studies, with a Morris dppc2 effect size of 0.38 (95% CI, 0.17-0.59). Despite initial high heterogeneity (I ² = 95.7%), identification and correction for selective outcome reporting bias mitigated this issue.

Clinical translation: CR has a modest but statistically significant impact on improving ED in patients with CVD, indicating its potential positive contribution to the quality of life of this group.

Strengths and limitations: The study's strengths include a comprehensive literature search and a rigorous methodological approach. Limitations involve high heterogeneity among studies and a low level of evidence due to small sample sizes and study quality; however, the source of heterogeneity was identified and mitigated following risk-of-bias assessment.

Conclusion: The results suggest that CR has a statistically significant but modest impact on improving ED in patients with CVD. Clinicians should consider the integration of CR into the clinical management of these individuals. This study underscores the potential for CR to contribute positively to the quality of life for patients with CVD by addressing associated ED (PROSPERO: CRD42022374625).

Background: Breast cancer (BC) is considered a risk factor for sexual dysfunction, which may be associated with the diagnosis itself or with oncological treatments. However, sexual dysfunction often remains underdiagnosed and unaddressed among BC survivors.

Aim: The study sought to evaluate the sexual function of postmenopausal BC survivors compared with postmenopausal women without BC.

Methods: This case-control study included 178 postmenopausal BC survivors (stages I-III), 45 to 70 years of age, with amenorrhea for ≥12 months and sexually active. They were compared with 178 women without BC, matched (±2 years) for age and time since menopause in a 1:1 ratio. Sexual function was evaluated using the Female Sexual Function Index (FSFI), which consists of 6 domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), with a total score ≤26.5 indicating risk of sexual dysfunction. Statistical analysis included Student's t test, chi-square test, and logistic regression (odds ratio [OR]).

Outcomes: Evaluation of sexual function in postmenopausal women treated for BC.

Results: Postmenopausal BC survivors showed poorer sexual function in the desire domain (P = .002). No significant differences were observed between groups in the other FSFI domains and total score (P > .05). Postmenopausal BC survivors had a higher prevalence of risk of sexual dysfunction (64.6% with a total score ≤26.5) compared with the control group (51.6%) (P = .010). Adjusted risk analysis for age and time since menopause revealed a higher risk of sexual dysfunction in BC survivors compared with women without cancer (OR, 1.98; 95% confidence interval, 1.29-2.96; P = .007). Among BC survivors, the use of hormone therapy was associated with a higher risk of sexual dysfunction (OR, 3.46; 95% confidence interval, 1.59-7.51; P = .002).

Clinical implications: Postmenopausal BC survivors should be regularly assessed before and throughout treatment to enable the early detection and diagnosis of sexual dysfunction.

Strength and limitations: The main strength is that this study might contribute to a better understanding of sexual function in postmenopausal BC survivors compared with women without BC. The main limitation is that while the FSFI is a valid and reliable tool for the evaluation of female sexual function, it does not allow a comprehensive diagnosis of sexual dysfunction, as it is not applicable to partners.

Conclusion: Compared with postmenopausal women without BC, postmenopausal BC survivors face a higher risk of sexual dysfunction, especially when treated with adjuvant hormone therapy.

Background: Pelvic floor muscle training can effectively improve pelvic floor muscle strength and activities; however, its impact on sexual function in women with stress urinary incontinence remains unclear.

Aim: The study sought to investigate the impact of pelvic floor muscle training on pelvic floor muscle and sexual function in women with stress urinary incontinence.

Methods: This was a retrospective observational study involving women who visited a urogynecologic clinic at a tertiary medical center. Patients with stress urinary incontinence without pelvic organ prolapse underwent pelvic floor muscle training programs that included biofeedback and intravaginal electrostimulation. Other evaluations included pelvic floor manometry, electromyography, and quality-of-life questionnaires, including the short forms of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Urogenital Distress Inventory, and Incontinence Impact Questionnaire.

Outcomes: Clinical characteristics, vaginal squeezing and resting pressure, maximal pelvic floor contraction, duration of sustained contraction, quality-of-life scores, and sexual function were compared between baseline and after the pelvic floor muscle training programs.

Results: There were 61 women included in the study. The mean number of treatment sessions was 12.9 ± 6.3, and the mean treatment duration was 66.7 ± 32.1 days. The short forms of the Urogenital Distress Inventory (7.7 ± 3.8 vs 1.8 ± 2.1; P < .001) and Incontinence Impact Questionnaire (5.9 ± 4.3 vs 1.8 ± 2.0; P < .001) scores significantly improved after the pelvic floor muscle training program. In addition, all pelvic floor muscle activities significantly improved, including maximal vaginal squeezing pressure (58.7 ± 20.1 cmH₂O vs 66.0 ± 24.7 cmH₂O; P = .022), difference in vaginal resting and maximal squeezing pressure (25.3 ± 14.6 cmH₂O vs 35.5 ± 16.0 cmH₂O; P < .001), maximal pelvic muscle voluntary contraction (24.9 ± 13.8 μV vs 44.5 ± 18.9 μV; P < .001), and duration of contraction (6.2 ± 5.7 s vs 24.9 ± 14.6 s; P < .001). Nevertheless, the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score demonstrated no significant improvement (28.8 ± 9.7 vs 29.2 ± 12.3; P = .752).

Clinical implications: Pelvic floor muscle training programs may not improve sexual function in women with stress urinary incontinence.

Strengths and limitations: The strength of this study is that we evaluated sexual function with validated questionnaires. The small sample size and lack of long-term data are the major limitations.

Conclusion: Pelvic floor muscle training can improve pelvic floor muscle activities and effectively treat stress urinary incont