Sexual medicine reviews最新文献

Introduction: Penile Mondor's disease (PMD) is a rare, benign thrombophlebitis of the superficial dorsal vein of the penis. Despite its distinctive clinical features, PMD remains under-recognized, and its optimal management is not well defined.

Objectives: This scoping review aimed to evaluate the current evidence on medical treatment and clinical outcomes of therapy in PMD.

Methods: A systematic search of PubMed, EMBASE, and Scopus was performed on July 25, 2025, using predefined keywords. Eligible studies included English-language peer-reviewed articles involving adult patients with PMD that reported clinical or radiological treatment outcomes. Case reports, reviews, conference abstracts, and non-English publications were excluded. Screening was performed independently by two reviewers, with disagreements resolved by a third.

Results: Five studies met inclusion criteria. Most cases of PMD were self-limited, resolving spontaneously within 4-8 weeks without sequelae. Conservative management (including sexual abstinence, non-steroidal anti-inflammatory drugs, and topical heparinoids) was effective in most patients. The role of anticoagulant therapy remains controversial and may be considered only in cases with proven thrombophilia or recurrent disease. Surgical interventions, such as thrombectomy or superficial vein resection, were rarely required and reserved for refractory cases. Importantly, PMD did not result in chronic erectile dysfunction. Transient erectile impairment during the acute phase was attributed to pain, vascular inflammation, and psychological distress, with full recovery observed after resolution.

Conclusion: Current evidence supports conservative therapy as the mainstay of PMD management. Pharmacological interventions may provide symptomatic relief, while surgical treatment should be limited to refractory cases. Larger prospective studies are needed to establish standardized protocols and clarify the role of thrombophilia screening.

Introduction: Male genital emergencies involving the penis are uncommon and necessitate immediate medical attention as well as surgery. The term "priapism" refers to a persistent erection caused by malfunctioning mechanisms that control rigidity, flaccidity, and penile tumescence. Identification of the underlying hemodynamics is necessary for a prompt and accurate diagnosis of priapism.

Objectives: To discuss the epidemiology, pathophysiology, and classification of priapism, as well as to give healthcare professionals up-to-date clinical evidence on the management of the priapism.

Methods: The members of the Fifth International Consultation for Sexual Medicine (ICSM) Committee 22 have conducted a review of the peer-reviewed scientific literature to present an objective, comprehensive analysis regarding the diagnosis and management of priapism. This report reviews the literature from 2010 to 2025 on priapism and concentrates on guidelines that have been written in the last ten years. Every relevant article was examined critically and discussed.

Results: This manuscript provides evidence-based diagnostic and treatment recommendations for ischemic, non-ischemic, recurrent ischemic priapism, and priapism in patients with sickle cell disease. The role of imaging, laboratory testing, early urologists' involvement when a patient presents to the emergency room, the discussion of conservative therapies, improved data for patient counseling regarding the risks of erectile dysfunction and surgical complications, specific recommendations regarding intra-cavernosal phenylephrine with or without irrigation, the inclusion of novel surgical techniques, and early penile prosthesis placement are all covered in this recommendation.

Conclusion: Every patient with priapism should have an emergency evaluation to determine whether they have acute ischemic or non-ischemic priapism, and those who have experienced an acute ischemic event should receive early intervention when necessary. Treatment for NIP must be based on the goals of the patient, the resources at hand, and the experience of the clinician; it is not an emergency.

Introduction: The issue of sexual dysfunction in infertile couples is often neglected and underreported. As sexual dysfunction can both contribute to and result from infertility, clinicians should be equipped to identify and address these issues as part of comprehensive fertility care.

Objectives: To develop evidence- and consensus-based recommendations for the clinical management of male sexual dysfunction (MSD) in the context of infertility.

Methods: Initial recommendations were formulated based on expert opinion and exploratory analysis of various types of MSD associated with infertility. A focused literature review was conducted for each topic, followed by iterative rounds of expert discussion to refine recommendations. Final consensus was achieved at the 5th International Consultation on Sexual Medicine meeting, and recommendations were rated using GRADE criteria.

Results: MSD and infertility often coexist, necessitating a detailed sexual history and physical examination during the initial infertility evaluation. Erectile dysfunction may be effectively managed with counseling, phosphodiesterase-5 inhibitors, or intracavernosal injections (eg, alprostadil, papaverine, phentolamine), which do not impair fertility outcomes. For low libido or unconsummated marriages, a multidisciplinary approach tailored to the couple's priorities-sexual function or fertility-is recommended. Ejaculatory disorders may be treated with counseling, penile vibratory stimulation, electro-ejaculation, medications, or assisted reproduction, depending upon the underlying cause. Selective serotonin reuptake inhibitors, used for premature ejaculation, may adversely affect sperm parameters and should be prescribed cautiously. Men with hypogonadism seeking fertility should avoid exogenous testosterone; alternatives such as selective estrogen receptor modulators, aromatase inhibitors, or gonadotropins may be considered. Lifestyle optimization, management of comorbidities, and use of fertility-safe lubricants can improve sexual and reproductive outcomes for couples trying to conceive.

Conclusion: MSD and infertility are often interrelated. Incorporating routine sexual health assessments into fertility evaluations enables clinicians to diagnose and treat MSD effectively, thereby improving both sexual function and reproductive success.

Introduction: Neuromuscular disorders (NMDs) comprise a group of conditions affecting the muscles and/or the nerves controlling them, resulting in progressive muscle weakness. Beyond the physical limitations, NMDs can significantly impact quality of life (QoL), including sexuality. Sexuality, as defined by the World Health Organization, encompasses physical, psychological, and social dimensions. However, research exploring the multifaceted impact of NMDs on sexual well-being remains limited, despite the potential influence of physical impairments, psychological distress, and social stigma.

Objectives: This scoping review aims to synthesize the existing literature on sexuality in individuals with NMDs, identifying the interplay of physical, psychological, and social factors affecting sexual QoL, highlighting research gaps, and informing future research and clinical practice.

Methods: A scoping review was conducted using PubMed, Web of Science, Cochrane Library, Embase, and Scopus databases (up to May 15, 2025) to identify studies examining sexuality in individuals with NMDs. Studies addressing physical, psychological, and social factors influencing sexual health in NMD patients were included. Data were extracted using a standardized form and synthesized narratively. The review was registered on Open OSF (DOI https://doi.org/10.17605/OSF.IO/RP9U2).

Results: Fourteen studies with various conditions such as Duchenne muscular dystrophy, amyotrophic lateral sclerosis (ALS), myotonic dystrophy type 1, myasthenia gravis, and Charcot-Marie-Tooth disease were included, from interviews to surveys. One key theme that emerged was the extent to which personal narratives reveal the emotional weight of stigma, the struggle with body image, and how intimacy is peripheral in medical institutions. In surveys, many said their sexual activity had declined, particularly among people with progressive diseases like ALS and myotonic dystrophy. Many of these studies also pointed to how sexual health was directly associated with QoL, a good reminder that it's an important aspect of well-being that we need to pay more attention to in care and support.

Conclusion: This scoping review highlights a significant gap in research regarding sexuality in individuals with NMDs. The limited number of studies identified underscores the need for further research to understand the complex interplay of physical, psychosocial, and social factors affecting sexual well-being in this population.

Introduction: Radical prostatectomy is one of the main causes of male sexual dysfunction after surgery, which leads to sexual health-related distress and needs for both men and their partners.

Objectives: This scoping review aims to sort out and summarize the current state of sexual health, sexual health distress and needs after radical prostatectomy (RP) for prostate cancer (PCa).

Methods: The review was conducted in accordance with PRISMA-ScR guidelines. Studies published between January 1, 2013 and June 1, 2024, were identified through systematic searches targeting research on sexual health distress, unmet needs, and support resources among PCa patients following RP. Both English and Chinese-language studies were considered. Two independent reviewers screened titles, abstracts, and full texts against predefined inclusion criteria, and extracted relevant data using an iterative consensus approach.

Results: Out of 4259 records, 53 studies were included for analysis. The findings indicate that PCa survivors and their partners experience significant physical, psychological, social, and informational unmet needs related to sexual health after RP. Sexual dysfunction remains under-communicated and poorly managed, with limited access to individualized interventions and psychosocial support. Many patients report feeling isolated and underserved.

Conclusions: Post-prostatectomy sexual health needs include physical dysfunction, psychosexual distress, limited support, and inadequate information. Addressing these requires multidisciplinary follow-up, individualized rehabilitation, partner-inclusive strategies, and accessible, reliable information to enhance patients' and partners' quality of life.

Introduction: With the proliferation of the Internet, the production, distribution, sharing, and use of child sexual abuse material (CSAM) is rising. Considered a global public health issue, the consumption of CSAM continues to go mostly undetected, which further calls for preventive measures.

Objectives: This systematic literature review aims to gather evidence regarding detected CSAM offenders' characteristics and typologies.

Methods: In July 2024, a comprehensive search of the databases EBSCO host, Web of Science, and PubMed was conducted. Three independent reviewers assessed the literature focusing on the characteristics and typologies of CSAM offenders. Data collection, analysis, and reporting were performed according to the PRISMA 2020 guidelines. Thirty-five articles were included in this review. Main findings were extracted based on CSAM offenders' risk factors and typologies.

Results: Child sexual abuse material offenders are mostly white men, ranging widely in age, with high levels of education and employment. These offenders tend to be single and have non-biological children. Adverse childhood experiences, along with cognitive distortions, are common among these individuals, who also have poor mental health, mood problems, and substance abuse, which serves as motivation for them to engage in CSAM. These offenders have few or no convictions at the time of detection; however, there is a perceived sexual attraction to children, along with consumption of extreme material, facilitated by easy access to the Internet.

Conclusion: This study provided an in-depth analysis of the typologies of CSAM offenders, making it possible to identify characteristics that are commonly present and to draw up a potential profile based on psychosocial (eg, sociodemographic, environmental, and psychological characteristics, trauma history, mental health condition, disruptive cognitions, and pattern behaviors) risk factors. These factors support typologies of users, highlighting consumers and distributors of this type of sexually abusive content, along with a profile that reflects consumption and child sexual abuse practices. For detailed analyses, please refer to Supplementary Table S1 and Supplementary Material S3.

Introduction: Benign prostatic hyperplasia (BPH) is an age-related condition affecting many men. Emerging evidence highlights a strong relationship between BPH, lower urinary tract symptoms (LUTS) and sexual dysfunction, including erectile dysfunction (ED), reduced sexual desire, hormonal imbalances, and ejaculatory dysfunction, warranting a comprehensive approach to diagnosis and management.

Objectives: This report aims to provide recommendations for identifying and managing sexual dysfunction associated with BPH and LUTS.

Methods: Based on guidelines from the International Consultation on Sexual Medicine, a literature review was conducted. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation system.

Results: The association between BPH, LUTS, and sexual dysfunction is significant, with ED, ejaculatory dysfunction, and hypogonadism being common complications. Lifestyle modifications, medical therapies, minimally invasive surgical therapies, prostate artery embolization, and surgeries (eg, Transurethral resection of the prostate, HoLEP, Aquablation) are among the recommended treatments. Each intervention carries varying risks of sexual dysfunction, requiring specific tailored treatment plans.

Conclusions: BPH/LUTS significantly affect sexual health, emphasizing the need for a multidisciplinary approach to management. Future research should refine diagnostic criteria and develop treatments that minimize sexual side effects. Enhanced education for patients and their partners could improve quality of life and coping mechanisms.

Introduction: Penile augmentation or penis enlargement surgery refers to any technique aimed at enhancing penile length or girth. These male enhancement surgical techniques can increase total penile length, either flaccid or erect, while others add to the penile shaft's girth and/or glans size. Proposed strategies include physical methods such as various penile exercises, mechanical traction devices, and medical therapy, while surgical interventions include cosmetic and phallic reconstructive techniques and use of fillers, sleeves, grafts, and flaps to augment penile size.

Objectives: The International Consultation on Sexual Medicine (ICSM) consensus statements provide evidence-based recommendations and aim to guide a clinical framework in penile aesthetic and augmentation.

Methods: A comprehensive literature search was conducted to identify published literature relevant to penile augmentation or enhancement. Preliminary consensus was presented to the delegates attending the 5th ICSM meeting, and feedback was incorporated into the final document.

Results: Twenty new recommendations are provided with corresponding levels of evidence and grades of recommendation.

Conclusions: Due to the controversies and lack of longer-term data regarding penile augmentation and cosmetic procedures, comprehensive assessments and careful patient counseling weighing the pros and cons, as well as potential complications, are mandatory before embarking on any treatment. Surgeons should be experienced in anatomy and various surgical techniques, and it is important to individualize surgical options based on patient condition(s) and needs, surgeon expertise, and local resources.

Introduction: Sexuality is integral to most women's quality of life. However, pregnancy and childbirth often lead to biological, psychological, and relational challenges that can impact sexual health and wellbeing. Research has documented declines in sexual activity, functioning, and satisfaction during the postpartum period, particularly among women who sustained severe perineal injuries during delivery. However, these issues remain scientifically and clinically underrecognized.

Objectives: Approximately 90% of primiparous women experience perineal tearing during vaginal delivery, with 5% sustaining an obstetric anal sphincter injury (OASI). This scoping review aims to synthesize existing evidence on the relationship between OASI and postpartum sexual health, focusing on three key dimensions: (1) sexual activity, (2) sexual functioning, and (3) sexual satisfaction. Understanding the impact of OASI on female sexual health is essential for providing tailored postpartum care and support.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, CINAHL, Cochrane, and "gray literature" sources to identify relevant peer-reviewed studies. The selection process involved three stages: screening of titles and abstracts, full-text evaluation, and final inclusion based on predefined criteria. Original quantitative studies presenting statistical evidence on the impact of OASI on postpartum sexual health were eligible for inclusion.

Results: Based on 33 articles, the scoping review revealed that women with OASI experienced delayed resumption of sexual intercourse compared to those with no or minor perineal tears. In addition, most studies reported that OASI increased the risk of dyspareunia, potentially persisting for years after childbirth. Several studies also observed a temporary or long-term decrease in desire, lubrication, orgasm ability, and overall sexual satisfaction. OASI was further associated with a heightened risk of long-lasting complications such as anal incontinence, which could contribute to or exacerbate sexual problems.

Conclusion: Women who sustain OASI during childbirth face an increased risk of postpartum sexual health issues. To mitigate these challenges, healthcare providers should encourage open discussions about sexual health and, when necessary, provide referrals to physiotherapy, couples therapy, or specialized sexological support.

Introduction: Neurogenic priapism is a rare but clinically significant manifestation of disrupted spinal autonomic control of erectile physiology. While most described following acute spinal cord injury (SCI), priapism has also been reported in association with chronic degenerative spinal pathology, suggesting distinct underlying mechanisms.

Aims: To synthesize reported cases of neurogenic priapism associated with spinal pathology and clarify how lesion level, injury chronicity, and autonomic pathway involvement influence priapism phenotype.

Methods: A narrative review of the literature was performed to identify published cases of priapism associated with SCI, lumbar spinal stenosis, and cauda equina pathology. Clinical features, spinal lesion characteristics, priapism subtype, management, and outcomes were extracted and qualitatively synthesized.

Results: We identified 10 case reports and case series comprising 17 neurogenic priapism cases (3 acute SCI, 14 lumbar stenosis). Onset was immediate with SCI and delayed with stenosis. Priapism following acute cervical or upper thoracic SCI typically occurred immediately after injury and reflected abrupt loss of sympathetic inhibition with preserved sacral parasympathetic outflow, resulting in sustained reflexogenic or, less commonly, ischemic priapism. In contrast, priapism associated with chronic lumbar spinal stenosis or cauda equina compression was uniformly non-ischemic, intermittent, and often activity-provoked, consistent with partial sacral root irritation and preserved arterial inflow.

Conclusion: Lesion level, injury chronicity, and the degree of autonomic pathway disruption are key determinants of neurogenic priapism phenotype. Recognition of these mechanistic distinctions may improve diagnostic accuracy, guide etiology-specific management, and reduce the risk of unnecessary invasive intervention in patients with spinal pathology.