Sexual Medicine最新文献

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.

Background: Although common repeat number polymorphisms in 3 hormone-related genes (AR, CYP19A1, and ESR2) have been implicated in the variations in several sexually dimorphic phenotypes, their contributions to the variations in gender identity (GI) and sexual orientation (SO) remain to be clarified.

Aim: To clarify the possible association between the repeat number polymorphisms and gender phenotype variations in the general population.

Methods: We used paper-based questionnaires to select 80 individuals with atypical gender phenotypes (the case group) and 114 control individuals (the control group) from 736 university students. The case group was further divided into two subgroups: one consisted of individuals with low GI scores (the atypical GI subgroup), and the other consisted of individuals with non-heterosexual orientation (the atypical SO subgroup). Repeat numbers of the longer and shorter alleles in each participant (Alleles 1 and 2) were examined through microsatellite analysis. Repeat numbers of AR in females were adjusted for the X chromosome inactivation status.

Outcomes: We examined the statistical differences in the repeat numbers between the case and control groups, and between each subgroup and the control group.

Results: The overall differences between the case and control groups and between each subgroup and the control group were small. However, the repeat numbers of AR in males of the case group were larger than those of the control group (P = 0.049), and the repeat numbers of ESR2 Allele 1 were larger in males of the atypical GI subgroup than in those of the control group (P = 0.046). In addition, females in the atypical SO subgroup had smaller repeat numbers of CYP19A1 Allele 2 than control females (P = 0.011).

Clinical implications: These results indicate the complex genetic basis of gender phenotype variations.

Strengths & limitations: This is the first study that addresses the possible association between common polymorphisms in hormone-related genes and gender phenotypes in the general population. Given the small number of our subjects and the modest differences in the repeat numbers between the case and control groups, our results await further validation.

Conclusion: The results indicate that the contribution of repeat number polymorphisms of the 3 genes to gender phenotype variations in the general population is small, although the repeat numbers of AR and ESR2 are potentially associated with atypical gender phenotypes in males.

[This corrects the article DOI: 10.1093/sexmed/qfaf024.].