Sexual Medicine最新文献

[This corrects the article DOI: 10.1093/sexmed/qfaf036.].

Background: Phosphodiesterase type 5 (PDE5) inhibitors are used to treat erectile dysfunction, but their cost can limit access.

Aim: This study examines PDE5 inhibitors pricing and demographic data across rural and urban New York State (NYS) counties, as well as small, large, and online pharmacies.

Methods: Prices from 133 chain pharmacies were collected from 15 randomly selected urban and 15 rural NYS counties. Counties without at least two large chain pharmacies were excluded. Data included small chains (n = 49), large chains (n = 84), rural (n = 57), urban (n = 76), and online pharmacies (n = 12). Prices for 20 tablets of sildenafil (100 mg) and tadalafil (20 mg) were gathered using GoodRx standard coupons. Price per unit for online pharmacies was calculated for quantities closest to 20 pills. Demographic data was sourced from the U.S. Census Bureau. This study was considered exempt from IRB review. Statistical analyses including t-tests, Wilcoxon rank-sum, and Kruskal-Wallis tests were performed using R Version 4.4.1 (2024-06-14).

Outcomes: The cash price of the PDE5 inhibitors across various pharmacy chain types and county types.

Results: Prices were lower in small chain pharmacies compared to larger chains (P < .001), but did not significantly differ between rural and urban counties (P > .6). Small chain rural pharmacies were cheaper than urban counterparts for sildenafil (P = .032). Online pharmacies offered the lowest and highest prices, with significant differences by chain type (P < .001) but not by county type (P > .100) for both drugs. Rural counties had a smaller Native Hawaiian (P = .001), Asian, Black/African American population and a larger White (P < .001) and American Indian population (P = .031). Median income was higher in urban counties (P = .010), but the percentage of the population without health insurance coverage did not differ (P = .177).

Clinical translation: This study aims to highlight the pricing variability of PDE5 inhibitors to help patients identify cost-effective options to circumvent potential financial barriers.

Strengths and limitations: This study was the first to examine PDE5 inhibitors pricing specifically within rural populations while also providing a comparative analysis of pricing differences between small and large pharmacy chains serving these communities. The study's limitations include a relatively small sample size of rural and small chain pharmacies resulting in power levels of 75% and 69%, respectively, which may impact the generalizability of the findings.

Conclusion: Enhancing drug price transparency for PDE5 inhibitors is vital for increasing access and pricing flexibility.

Background: The linkage between type 2 diabetes (T2DM) and erectile dysfunction (ED) is not yet fully understood.

Aim: This study aims to evaluate the causal influence of T2DM on ED and to determine whether plasma proteins mediate this relationship using Mendelian randomization (MR).

Methods: We extracted data on T2DM and plasma proteins from multiple genome-wide association study databases, encompassing European and East Asian populations. The ED dataset comprised 223 805 individuals of European descent. A 2-sample MR analysis was conducted using inverse-variance weighted (IVW), MR-Egger, weighted median, and weighted mode methodologies. Additionally, mediation and sensitivity analyses were performed to assess the robustness of the findings and the mediating role of plasma proteins.

Outcomes: The MR analysis revealed a significant increase in ED incidence associated with T2DM (IVW-fixed odds ratio [OR] = 1.091, 95% confidence intervals [CI]: 1.084-1.098), with sensitivity checks confirming no pleiotropic outliers.

Results: We identified 127 plasma proteins linked to ED, of which 15 were influenced by T2DM. The mediation MR analysis indicated 9 plasma proteins with consistent mediation effects: SERPINA10, MATN4, NAB1, NUCB1, SLAMF6, and ANG were associated with negative effects, while NCAM1, CTSB, and WFIKKN2 demonstrated protective effects.

Clinical translation: These findings suggest that T2DM has a direct causal effect on ED, with several plasma proteins serving as potential mediators, highlighting the importance of targeting these proteins for future therapeutic interventions in ED among T2DM patients.

Strengths and limitations: This study leverages a comprehensive MR approach and a large sample size, though it is limited by the observational nature of genetic associations and the necessity for further clinical validation.

Conclusion: The study enhances our understanding of the biological mechanisms linking T2DM and ED, highlighting plasma proteins as potential mediators and targets for therapeutic development.

Background: Genito-pelvic pain and penetration disorder (GPPPD) affects multiple aspects of a woman's life, yet its biopsychosocial impact in the Italian context remains underexplored.

Aim: This study aimed to investigate differences in psychosocial and sexual well-being between women with and without self-reported GPPPD.

Methods: A sample of 310 women (M _age = 29.08 ± 7.93, range = 18-57) was recruited and divided into two groups: 141 women who self-reported suffering from GPPPD and 169 women who reported not suffering from it. Data were collected through online platforms and the Italian versions of the Vaginal Penetration Cognition Questionnaire, the Toronto Alexithymia Scale, the Parental Bonding Instrument, the Romance Qualities Scale, the Female Sexual Function Index, and the Satisfaction with Life Scale were administered. Since there is no Italian version of the Vaginal Penetration Cognition Questionnaire, its psychometric properties were preliminarily evaluated in an independent and convenience sample of 170 women (M _age = 28.28 ± 7.64, Range = 18-49). To explore whether the two groups differed on the study variables, a series of multivariate analyses of variance were carried out.

Outcomes: The outcomes of the study were the levels of the vaginal penetration-related cognitions, alexithymia, relationships with mother and partner, and life and sexual satisfaction.

Results: Women with GPPPD reported higher negative cognitions related to penetration, higher levels of alexithymia, a lower quality of the relationship with both the partner and the mother, as well as lower life and sexual satisfaction than the control group.

Clinical translation: These findings emphasize the need for multidisciplinary approaches addressing cognitive, emotional, and relational factors to improve the well-being of women with GPPPD.

Strengths and limitations: Strengths include the comprehensive assessment of biopsychosocial factors. Limitations involve reliance on self-reported diagnosis, potential recruitment bias, and the cross-sectional nature of the study.

Conclusion: The study highlights the extensive impact of GPPPD on women's well-being, emphasizing the importance of tailored interventions targeting the disorder's psychological and relational dimensions.

Background: Growing evidence suggests that alterations in the gut microbiota may contribute to the pathogenesis of erectile dysfunction (ED).

Aim: To investigate the potential causal relationship between specific gut microbial taxa and ED, identify key microbial metabolites and their associated target genes, and evaluate their therapeutic potential through computational drug screening.

Methods: Genome-wide association study (GWAS) summary statistics for gut microbiota and ED were obtained from the MiBioGen, IEU OpenGWAS, and FinnGen databases. Mendelian randomization (MR) analysis was performed using the TwoSampleMR package to assess potential causal relationships. A microbiota-metabolite-target gene network was constructed using data from GutMGene, Super-PRED, and GeneCards databases to explore the microbiota-host interaction axis. The DeepPurpose machine learning framework was utilized to predict drug-target binding affinities, and top-ranking drug-gene pairs were validated by molecular docking to assess binding free energies and confirm interaction stability.

Outcomes: The study aimed to identify specific gut microbiota, metabolites, and target genes associated with ED and evaluate their therapeutic potential.

Results: MR analysis revealed a negative association between ED and the gut microbial genera Alistipes, Butyricicoccus, and Dialister, suggesting a potential protective role. Machine learning predictions indicated strong binding affinities between target genes (NFKB1, TLR4, CYP3A4) and bile acid derivatives (Tauroursodeoxycholic acid and Taurochenodeoxycholic acid). Molecular docking confirmed high binding affinities of NFKB1 to Tauroursodeoxycholic acid (-9.81 kcal/mol) and Taurochenodeoxycholic acid (-9.35 kcal/mol).

Clinical implications: These findings suggest that gut microbiota and their metabolites could serve as potential therapeutic targets for ED interventions.

Strengths and limitations: The study provides novel insights into the gut microbiota-ED relationship by integrating multi-omics data and advanced computational methods. However, validation in preclinical or clinical studies is needed to translate these findings into therapeutic applications.

Conclusion: Specific gut microbiota, through metabolites and associated target genes, may influence the onset of ED. These findings highlight potential therapeutic targets and provide a basis for future interventions in ED treatment.

Background: There is a presumed yet untested connection between sexual compulsivity and pedophilic interest among sexual offenders against children, which has driven the widespread use of anti-libidinal treatments for high-risk offenders.

Aim: To test the hypothesis that compulsive sexual behavior (CSB) and pedophilic interest are related.

Methods: A group of 95 prisoners in treatment for sexual offenses was administered questionnaires measuring CSB, and their self-reported offense history analyzed in order to assess their level of pedophilic interest.

Outcomes: All subjects were able to provide valid details of their sexual behavior and of their previous sexual offending, and there was a wide distribution of scores on both measures.

Results: Contrary to the main hypothesis, the findings revealed a negative relationship between CSB and pedophilic interest. Further analysis indicated that the main factor of CSB underlying this relationship was a lack of negative affect, together with non-significant negative trends toward the unwanted consequences and affect dysregulation components of CSB in relation to pedophilic interest.

Clinical implications: These results challenge the assumption that targeting CSB through anti-libidinal medication should be the primary intervention for offenders with elevated sexual interest in children. Instead, multifactorial approaches to sexual offending may yield more meaningful long-term effects on offender risk.

Strengths and limitations: This study is the first to explore the relationship between CSB and pedophilic interest in convicted offenders, providing valuable insights into their management and treatment. However, its findings are limited by treating pedophilic interest as a continuous variable, despite evidence suggesting it may be a taxon, potentially restricting the broader applicability of the results.

Conclusions: The study concludes that compulsive sexual behavior and pedophilic interest are not inherently linked in incarcerated offenders. This underscores the need for nuanced, individualized treatment approaches that align with multifactorial models of sexual offending. Clinically and at the policy level, this calls for a shift away from a sole focus on anti-libidinal treatments toward interventions tailored to address the complex and varied needs of this population.

Background: There is limited research about the prevalence of receptive anal intercourse (RAI), erogeneity and sexual pleasure within the zones of the rectum.

Aim: We describe the experience of RAI within a large and diverse population in an online convenience survey, to map zones of erogenous sensation within the rectum, and to assess orgasm function among individuals who practice RAI.

Methods: Adult subjects were recruited from an online survey platform and were queried about their history of RAI. Those who endorsed RAI were shown illustrations of the rectum divided into four non-overlapping anatomic regions. Subjects designated regions where they experienced pleasure when touched during RAI. Subjects were also asked about their ability to achieve orgasm from RAI alone or if they required co-stimulation of additional regions. Demographics were collected, and differences were analyzed based on gender, age, and sexual orientation identity.

Outcomes: Outcomes include mapped erogeneity of the rectum among men and women and self-reported experiences with RAI, including orgasm function related to RAI among cisgender adults.

Results: A total of 466 cisgender men (mean age ± SD, 46.3 ± 17.5 years) and 498 cisgender women (48.1 ± 16.0 years) completed the questionnaire. Women were significantly more likely to endorse prior RAI, as compared to men (34% vs 24%, P < .01). Men were significantly more likely to endorse achieving orgasm from RAI alone, as compared to women (39% vs 19%, P < .05). Gay men and women were more likely to have participated in RAI. The superficial anterior rectum was the most frequently selected region by both men and women as a site of pleasure when touched during RAI.

Clinical implications: The results of this study will highlight preferred zones of erogeneity in the rectum, which could be impacted by surgeries or pathology in these areas.

Strengths and limitations: This study captured a comprehensive assessment of erogenous sensation within the rectum among a large sample. Limitations include the use of a online subjects for data collection, which can result in both response and selection bias.

Conclusion: Our findings show that RAI is practiced by many adults across ages, gender, and sexual orientation identities. Both men and women report pleasure from various areas within the rectum, primarily the superficial regions of the rectum. These findings may prove helpful in elucidating practices of RAI. Additionally, understanding erogeneity in the rectum may allow providers to better predict changes due to pathology and treatments of or surrounding these areas.

Introduction: The necessity for continuous, digitally accessible education in sexology-viewed from an international perspective and adhering to the highest quality standards-has driven the development of the work presented here.

Objectives: The objective of this paper is to enhance understanding of theory-based continuous education in sexology by informing readers about relevant theoretical perspectives and their applications.

Methods: First, we outline 2 foundational models in continuous education to provide context for how they shape adult learning practices. Second, building on these models, we introduce a novel conceptual framework for continuous education in sexology. Third, to exemplify the application of our conceptual framework, we present a roadmap for implementation, along with insights gained from the development of a continuous education platform.

Results: Two of the most prominent models of continuous education are the andragogy and transformative learning models. The key point of the andragogy model is to tailor educational practices to the needs of adult learners, recognizing their existing knowledge and life experiences, promoting self-directed learning, and fostering a collaborative environment that encourages critical thinking and practical application of concepts. The key point of the transformative learning model is to facilitate personal and social change by encouraging learners to critically reflect on their experiences and challenge assumptions. Building upon these 2 models, a new model emerged, namely the International Online Sexology Supervisors (IOSS) conceptual framework for continuous education in sexology. This model posits that continuous education is more effective when driven by intrinsic motivation, and such learning will thrive in environments that promote (1) transformative learning, (2) autonomous learning, and (3) learning embedded in the workflow. In alignment with the IOSS conceptual framework, the IOSS learning platform has been developed, and its implementation roadmap is presented here. This roadmap outlines 10 key components and strategies for content design, instructor recruitment, pricing, marketing, accreditation, evaluation, and technology usability, all working together to create a continuous education learning environment for sexologists.

Conclusion: Learning environments that incorporate the key features of the IOSS conceptual framework are possible. An example of an educational approach that integrates these elements into a cohesive strategy is presented. E-learning can play a significant role in the continuous education of sexual health professionals. We hope that the IOSS model and its applications will spark discussions and encourage relevant initiatives within the field.