Sexual medicine reviews最新文献

Introduction: Testosterone replacement therapy is gaining more and more popularity among hypogonadal men. The positive effects on body composition, metabolic functions, and mental well-being can improve the quality of life of many men. However, testosterone can also trigger several side effects, including increases in hematocrit and hemoglobin levels. Exogenous testosterone tends to increase erythropoiesis. The testosterone-induced increase in red blood cells can increase performance via improved transport of oxygen to the body. However, red blood cell overproduction can cause blood clots and severe sequelae such as heart attack, stroke, or pulmonary embolism. These side effects need to be closely monitored in testosterone replacement therapy (TRT) patients. Traditionally, cessation of TRT was recommended for patients with severe polycythemia. However, cessation of TRT can lead to the recurrence of symptoms experienced before TRT. Fortunately, recent innovations in testosterone preparations allow a treatment with less side effects on hematocrit levels.

Objectives: This review focuses on highlighting novel methods to treat hypogonadism while minimizing side effects related to hematocrit levels.

Methods: We identified relevant articles using PubMed and Google Scholar searching for specific terms from 2000-2024.

Results: Elevations in hematocrit levels triggered by testosterone therapy seem to be controversial, some studies advocate noninferior effects as compared to placebo while others found adverse side effects on cardiovascular health. However, the way of administration of testosterone seems to strongly influence the extent of hematocrit increases and can therefore be minimized by choosing the right testosterone preparation.

Conclusion: Depending on the route of administration, testosterone replacement therapy can lead to significant increases in hematocrit and potential cardiovascular incidents. On the other hand, for hypogonadal patients with anemia, testosterone replacement therapy might be beneficial not only for restoring healthy testosterone levels but also red blood cells.

Introduction: Chondrolaryngoplasty, also known as "Adam's apple" reduction, is a surgical procedure that diminishes the prominence of the thyroid cartilage. Primarily sought by transgender women, the procedure is performed for esthetic reasons to align with their identified gender. It can also be done for cisgender individuals seeking reduced prominence. Despite its safety, there are risks due to the proximity to vocal cords, and variations may impact results.

Objective: To identify the main techniques available in the literature for performing chondrolaryngoplasty, as well as the differences in the results of each technique applied.

Methods: Research utilized databases (MEDLINE, PubMed, and Scopus) from inception to March 2023, focusing on randomized clinical trials, prospective and retrospective studies, and case series published in English, Spanish, French, or Portuguese. Selected studies provided results including satisfaction rates, surgical time, and/or details on complications.

Results: 21 eligible results, four of which were excluded because the full text was not available and four because they did not meet the research objectives. Thus, 13 articles were included in the analysis, eight of which reported on external approach surgical procedures (via surgical incision) and five on transoral procedures, totaling 355 living patients evaluated, as well as 11 cadavers. The complications reported are considered mild and transient, and do not contraindicate the procedure. Among the factors that most interfere with patient satisfaction is the apparent scar, which is avoided with the transoral surgical approach, which has been reported more recently.

Conclusion: Chondrolaryngoplasty is an esthetic surgical procedure that aims to reduce the prominence of the thyroid cartilage and is most commonly performed on transgender women. Studies show that it is a safe procedure, with rare complications that are generally transient. The main drawback of the surgery is the apparent scar which can be avoided by a transoral approach.

Introduction: Patient medical and surgical history factors, such as prior prostatectomy, may lead surgeons to opt for ectopic reservoir placement rather than the standard reservoir location in the retropubic space (RPS) during inflatable penile prosthesis (IPP) placement.

Objective: To examine the safety and effectiveness of ectopic reservoir placement used with three-piece IPPs in relation to reservoir placement in the RPS.

Methods: A systematic review of MEDLINE/Pubmed and Embase databases was performed for literature between 1970 and 2022. Clinical studies and case reports describing three-piece IPP reservoir placement and clinical outcomes on AMS 700, similar products (such as Coloplast Titan), and three-piece IPPs where the manufacturer is not specified were included.

Results: Seventy articles were identified that reported clinical outcomes on three-piece IPP reservoir placement, which included data on 9565 patients. Of these, 67% of the reservoirs (n = 6413) were placed in ectopic locations. These locations were defined as submuscular (n = 5207), retroperitoneal (n = 405), sub-external oblique (n = 50), peritoneal (n = 42), subcutaneous (n = 10), and did not specify the ectopic location (n = 694). A total of 670 patients had ectopic placement of the AMS 700 reservoirs specifically. Overall, there were no elevated rates in safety outcomes between RPS and ectopic placement. Fourteen studies directly compared safety and/or efficacy outcomes between RPS and ectopic placement and did not report any significant differences between patient groups.

Conclusions: Ectopic reservoir placement of three-piece IPPs, including AMS 700, is comparable in terms of safety, efficacy, and patient satisfaction to RPS reservoir placement. Ectopic reservoir placement of the AMS 700 device is also similarly comparable to ectopically placed reservoirs of other IPPs as reported in the literature. Surgeons should consider ectopic implantation for patients at higher risk of complications associated with reservoir placement into the RPS.

Introduction: Pelvic floor physical therapy (PFPT) and noninvasive modalities can be more safe and available treatments for vaginal laxity (VL) with less risk of postsurgical complications.

Objectives: The purpose of this review is to define the concepts of PFPT and noninvasive modalities, examine the evidence supporting those modalities as a treatment for VL, and evaluate their effectiveness.

Methods: Between 2002 and 2023, clinical studies including women diagnosed with VL were examined in the Web of Science, Cochrane Library, Scopus, and PubMed databases. Exclusion criteria included studies with no outcomes or inadequate data, procedures, suggestions, editorials, book chapters, letters to editors, reviews, meta-analyses, animal research, and articles in languages other than English.

Result: Only seventeen studies have been identified. Four studies have demonstrated the impact of PFPT (low- and medium-energy radiofrequency (RF), ultrasound, low-energy laser treatment, par sacral stimulation, the knack method, and pelvic floor exercises), and thirteen studies have discussed the impact of noninvasive modalities (RF, combined multipolar RF with pulsed electromagnetic, combined RF and pulsed electromagnetic field, high-intensity focused ultrasound, CO2 laser, combining multipolar RF and hybrid fractional laser, microfocused ultrasound, and the VIVEVE surface-cooled RF) on vaginal laxity.

Conclusion: This review indicates many knowledge areas that must be attempted in order to understand the influence of nonstrengthening physical therapy and noninvasive methods on vaginal laxity. In addition to the mechanisms behind their impacts. In addition, we strongly recommend that more clinical trials of high methodological and interventional quality are required to investigate the efficacy of various physical therapy approaches, including electrical stimulation, biofeedback exertion, acupressure, manual therapy, neuromodulation, core exercise therapy, hydrotherapy, well-designed ultrasound therapy protocols, and vaginal weight training.

Introduction: Female sexual dysfunction (FSD) remains a silent problem, especially in Arabic-speaking countries and the Middle East and most of the data are from Western countries. Sociocultural determinants haven't been getting the same attention as biological and psychological factors when studying sexual health.

Objectives: To assess the prevalence of FSD in the Arab and Middle Eastern world and understand the sociocultural determinants related.

Methods: On January 13, 2024, we searched electronic databases including Pubmed, Scielo, PsycArticles, Scopus, Cochrane Library and Google Scholar, Middle East Current Psychiatry, and Journal of Middle East Women's Studies, following PRISMA guidelines. Female participants, aged at least 16 years old from Middle East or Arabic-speaking countries, including North Africa, and cross-sectional studies in Arabic, English, and/or French were included. After careful screening of titles, abstracts, and full texts, ineligible articles were excluded.

Results: A total of 19 papers were included in the present review. The most common FSD in each country were as follows: in Egypt, Turkey, Morocco, and Jordan, desire problems. In Iran, orgasm problems, and pain. In Palestine, pain. In Saudi Arabia, arousal. Sociocultural determinants such as language, poor sexual education, poor sexual self-awareness-and of partners-, lack of training, and help-seeking were related to FSD.

Conclusions: FSD is prevalent in Arabic-speaking countries and the Middle East, yet little to no attention is given to this matter. Causes for FSD are mainly cultural, and Arab and Middle Eastern healthcare professionals lack training. Culturally sensitive, evidence-based studies regarding sexual health need to be conducted.

Introduction: Temporomandibular disorders (TMDs) encompass various conditions affecting the temporomandibular joint and surrounding structures, often presenting with pain, limited movement, and functional impairments. TMDs may affect kissing and oral sex, in addition to influencing sexual function, as any other chronic pain condition.

Objective: The study sought to examine the connection between TMDs and sexual function.

Methods: A literature review was conducted, synthesizing evidence from various disciplines, including dentistry, physical therapy, psychology, and sexual medicine. Relevant studies were analyzed to elucidate the multifaceted nature of TMDs and their potential impact on sexual health.

Results: Emerging evidence suggests a complex relationship between TMDs and sexual function, with chronic pain, psychological distress, and physiological factors potentially contributing to sexual dysfunction.

Conclusion: Understanding the interconnectedness of TMDs and sexual function is essential for providing comprehensive care. Further research is needed to assess the association between TMDs and sexual dysfunction, elucidate the underlying mechanisms, and develop targeted interventions that address both TMD symptoms and sexual health concerns.

Introduction: This review explores the interplay between comorbid insomnia and sleep apnea (COMISA) and erectile dysfunction (ED), 2 conditions that significantly impact men's health. COMISA, a recently recognized condition characterized by the coexistence of insomnia and obstructive sleep apnea, has been shown to disrupt sleep architecture and cause intermittent hypoxia. These disturbances are increasingly linked to the exacerbation of ED, a prevalent issue among men. Understanding the connection between COMISA and ED is crucial for developing integrated treatment approaches that address both sleep and sexual health.

Objectives: We aim to explore the epidemiological, physiological, and potential therapeutic intersections of COMISA and ED. This review sets out to develop a better understanding of the relationship between these conditions and to emphasize the need for an integrated diagnostic and therapeutic approach that addresses both sleep and sexual health.

Methods: Through a comprehensive analysis, including a detailed examination of extant studies, we address the hormonal imbalances and alterations in neural pathways that collectively contribute to the complex pathophysiology of ED and how these are particularly susceptible to the concurrent presence of COMISA.

Results: Our analysis indicates that disruptions in sleep architecture and intermittent hypoxia associated with COMISA can exacerbate ED. Hormonal imbalances, endothelial dysfunction, autonomic imbalance, and increased inflammation and oxidative stress are key mechanisms through which COMISA influences ED. These factors collectively impair vascular health, reduce testosterone levels, disrupt neural control of erections, and contribute to the severity of ED.

Conclusions: This review underscores the necessity for an integrated approach to diagnosis and therapy that considers both sleep and sexual health to improve overall outcomes. These insights should foster a deeper understanding of the relationship between COMISA and ED, encourage further research in this area, and potentially lead to the development of innovative treatment strategies to manage these closely intertwined health concerns.

Introduction: The use of hyaluronic acid as a nonsurgical treatment for various conditions within urology has been of great interest in recent literature.

Objectives: In this study, we aimed to provide an updated review and analysis of the current state of hyaluronic acid use in urology, characterize its adverse effects, and briefly discuss future directions of research for hyaluronic acid in urology.

Methods: PubMed searches were run utilizing multiple terms, including "hyaluronic acid," "penile," "augmentation," "Peyronie disease," "premature ejaculation," and "cosmetic urology," among other related iterations. Relevant data extracted included International Index of Erectile Function score, intravaginal ejaculatory latency, glans circumference, penile girth, and plaque size. We also included studies which reported on complications of hyaluronic acid injections. Aggregated analysis was performed on studies with complete pre and post injection data at time closest to 6 months postinjection.

Results: A total of 33 studies met our inclusion criteria. Studies had marked heterogeneity in design, but most reported positive results. A total of 16 studies were included in our analysis. Intravaginal ejaculatory latency, penile girth, glans circumference, and International Index of Erectile Function were all increased on a fixed-effects model. Reduction in plaque size was not significant (P = .069). Complications were rare.

Conclusion: Literature on hyaluronic acid for urologic issues demonstrates promising results; however, the quality of studies was variable. Our analysis of these studies largely corroborates these findings; however, the results are limited by the data available. Hyaluronic acid may be promising, but we highly implore standardization of study regimens in randomized controlled trials.