Sexual medicine reviews最新文献

Introduction: Many erectile dysfunction (ED) patients respond inadequately to phosphodiesterase type 5 inhibitors (PDE5is). Non-pharmacological interventions (NPIs) have emerged as potential alternative or adjunct treatments for improving erectile function.

Objectives: This study aimed to evaluate and compare the efficacy and safety of various NPIs for ED through a systematic review and network meta-analysis.

Methods: Registered in PROSPERO (CRD420251083286), this NMA followed PRISMA guidelines. Eight databases were searched for RCTs through December 2025. Evaluated NPIs included Electrical Stimulation (ES), Exercise, Low-intensity Extracorporeal Shockwave Therapy (Li-ESWT), Acupuncture-Based Therapies (ABT), and Hyperbaric Oxygen Therapy (HOT). Outcomes were the International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS), Peak Systolic Velocity (PSV) and Adverse Events (AEs). Risk of bias (RoB 2.0) and evidence certainty (CINeMA) were independently assessed.

Results: 31 RCTs (1874 participants) were included. For IIEF-5, ES + Exercise indicated the most notable improvement versus Sham/Placebo (Mean Difference [MD] = 6.81, 95% CI 3.50-10.12; Surface Under the Cumulative Ranking Curve [SUCRA] 98.1%; high-certainty evidence).ES alone also showed significant gains (MD = 2.86, 95% CI 0.86-4.85; SUCRA 82.3%; high-certainty evidence). Li-ESWT offered modest benefits (MD = 0.65, 95% CI 0.00-1.29), while HOT and other modalities ranked lower in efficacy. Regarding secondary outcomes, ES was most associated with EHS improvement (MD = 3.38), and Li-ESWT+Exercise with PSV increase (MD = 7.33). No serious AEs occurred; minor events included transient muscle strain and headache. Evidence certainty ranged from low to high.

Conclusion: This network meta-analysis suggest that NPIs, especially ES-based therapies, can significantly improve ED. ES combined with Exercise showed the most consistent and clinically meaningful benefits. However, the overall quality of evidence remains low due to intervention variability and small sample sizes. Further large-scale, high-quality trials are necessary to confirm the long-term efficacy and safety of these interventions across diverse patient populations.

Introduction: Low-intensity shockwave therapy (LiSWT) is a novel treatment option for patients with erectile dysfunction (ED). To date, numerous randomized controlled trials (RCTs) and cohort studies have been published.

Objectives: To critically evaluate the methodology and limitations of the published studies on LiSWT for ED.

Methods: A literature search was performed. We excluded studies that compared and/or combined LiSWT to other therapies. In the context of multiple studies from the same center with identical populations and study design, we selected the studies with the largest patient population and/or longest follow-up. Attention was focused on patient demographics, device parameters, treatment protocols, endpoints, and follow-up schedules.

Results: 45 studies (25 cohort, 20 RCTs) using 9 different LiSWT devices were analyzed. Most studies excluded men with severe ED: 6 included men with pelvic surgery and/or radiation and 22 studies included phosphodiesterase 5 inhibitor non-responders. The population size for the cohort studies had mean 61.12 patients (SD 80.34), median 40.0 (IQR 27-54). In the RCTs, the mean per arm was 38.13 patients (SD 19.25), median 35 (IQR 23-42.5). Patients received between 3000 and 90 000 total shocks during the treatment courses, with 1-5 sessions per week and 2-10 application sites included. The most common endpoint was change in the International Index of Erectile Function. Only 17 trials evaluated objective endpoints, such as penile duplex Doppler ultrasound. Study follow-up duration ranged between 1 and 36 months with a median of 6 months.

Conclusion: The methodology applied to the published LiSWT studies is remarkably heterogeneous, with a 30-fold difference in shock number and a 5-fold difference in weekly session number and number of application sites. These data emphasize the current inability to compare results across studies using nine different devices and disparate treatment protocols.

Background: Kidney failure significantly affects sexuality, particularly female sexual function.

Aim: This study aims to map current knowledge regarding the sexuality of women undergoing hemodialysis (HD).

Methods: A scoping review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Databases searched included MEDLINE, Web of Science, and gray literature sources up to August 2023. The guiding question was: "What is the available evidence on sexuality in women on hemodialysis?" Studies containing the terms "sexuality," "women," and "hemodialysis" were included, without language or publication date restrictions.

Results: From 1048 initially identified articles, 23 met inclusion criteria. An additional 15 gray literature studies were included, totaling 38 studies involving 2165 women on HD. Sexual dysfunction was highly prevalent, with a pooled estimate of 87%. Most studies (61.5%) used the Female Sexual Function Index to assess dysfunction. Women on HD presented higher rates of dysfunction compared to other stages of chronic kidney disease. Sexual dysfunction was often associated with poor quality of life, depression, and anxiety. Only four studies used qualitative methods, addressing topics such as gender roles, social constructs of sexuality, the impact of treatment on sexual health, and access to professional support.

Conclusion: Women on HD face high rates of sexual dysfunction, closely linked to mental health and quality of life. Qualitative research on their lived experiences remains scarce and deserves further attention.

Introduction: While testosterone replacement therapy (TRT) is generally effective in restoring testosterone levels and improving quality of life, its dermatological adverse effects are underreported compared to cardiovascular and oncologic risks.

Objective: This review aims to synthesize existing evidence on cutaneous complications associated with TRT to better inform clinical practice.

Methods: A scoping review was conducted using PubMed, Scopus, and Cochrane databases to identify studies reporting dermatologic adverse events related to TRT in adult men. Inclusion criteria focused on original studies documenting skin-related side effects in TRT recipients. Ten studies met eligibility: eight prospective clinical trials and two retrospective chart reviews published between 2006 and 2025. Data were extracted and summarized narratively.

Results: Across all included studies, dermatologic adverse events were consistently reported. Acne was the most frequent, affecting 0.6%-9.1% of participants, with the lowest incidence in oral formulations. Pruritus occurred in up to 10.0%, rashes in up to 5.3%, and abnormal hair growth in up to 5.3%. Injectable formulations were generally associated with higher rates of acne and systemic reactions than topical or oral preparations. Despite the prevalence of these effects, most studies lacked standardized reporting or detailed management strategies.

Conclusions: Dermatologic side effects of TRT, though often considered non-severe, can significantly impact patient satisfaction, adherence, and quality of life. Acne and other cutaneous reactions vary by delivery method and patient susceptibility, emphasizing the need for clinician awareness, patient counseling, and better adverse event reporting. Future research should standardize dermatologic outcome measures and explore effective prevention and management strategies to improve the safety and tolerability of TRT.

Introduction: Sexual shame, a nuanced subset of general shame, is relatively nascent in the sexual wellbeing literature. Resulting from negative self-evaluation, sexual shame may be activated by sexual experiences, thoughts, desires, and behavior and involves feeling inherently flawed and abnormal as a sexual being. Sexual shame's impact on sexual wellbeing can be intuited from related research. Trauma-related shame, for example, is a critical target for clinical treatment, and sex guilt is known to impact sexual wellbeing. Sexual shame, while related to these concepts, is distinct and deserves a deeper understanding of its unique role in sexual wellbeing.

Objectives: This narrative review provides an overview of the sexual wellbeing research that intentionally measures sexual shame.

Methods: A literature search was conducted through PsychInfo, PsycARTICLES, and PubMed using the search term sexual shame. Articles were included if they were empirical studies published in English that presented original findings and explicitly measured sexual shame as a key variable.

Results: Sexual shame is linked to numerous facets of sexual wellbeing. It is a significant consequence after nonconsensual sexual experiences and acts as a mechanism for sexual dysfunction. Sexual shame plays a key role in the cycle of hypersexuality, either perpetuating it or promoting help-seeking behavior. Sexual shame may be an important contributor to general sexual dysfunction, especially in women, but the results are mixed. When individuals believe they are transgressing religious sexual norms, sexual shame is higher, especially regarding pornography use and masturbation.

Conclusion: A clearer understanding of sexual shame's role in sexual wellbeing is vital as it holds significant relationships to numerous components of sexual wellbeing. The current research has methodological limitations regarding measurement (eg, unvalidated measures, conflation with related concepts). Future research must prioritize justified, validated measures of sexual shame to better understand this key factor in sexual wellbeing.

Introduction: Virtual reality (VR) has emerged as a promising technology in medicine, offering innovative approaches for diagnostics, treatment, and patient education. However, its role in male sexual dysfunction (MSD) management remains underexplored, particularly among urologists.

Objectives: To review the current evidence on the use of VR in the diagnosis and treatment of MSDs, assessing its feasibility, efficacy, and potential integration into clinical practice.

Methods: A comprehensive bibliographic search for a narrative review was conducted in October 2024 using Google Scholar, PubMed, Scopus, and Web of Science to identify literature on VR applications in MSD management. The PICO framework of article selection was employed to include prospective and retrospective studies evaluating VR-based diagnostic and therapeutic interventions for MSD. Studies involving nonmale participants, nonsexual applications of VR, and technologies not classified as immersive VR (eg, televisions and laptops) were excluded.

Results: In erectile dysfunction, VR-based audiovisual sexual stimulation (VR-AVSS) has demonstrated potential for assessing erectile function, providing an objective measure of arousal through RigiScan-based monitoring. Additionally, VR has been studied in psychosexual therapy, showing promise in managing performance anxiety and related psychological factors contributing to MSDs. In premature ejaculation, VR-based interventions may complement existing psychosexual and pharmacological treatments by facilitating behavioral training in immersive environments. While no clinical studies have directly examined VR applications in Peyronie's disease, theoretical models suggest its utility in patient education and 3-dimensional curvature simulation, aiding treatment planning and adherence. Emerging applications of VR in forensic settings include the assessment of sexual preferences, aversion disorders, and deviant sexual behaviors, utilizing physiological and eye-tracking metrics to enhance diagnostic accuracy.

Conclusion: While current research has predominantly focused on psychological interventions, VR's potential in urological practice remains largely unexplored. Future studies are needed to validate VR's efficacy, optimize its clinical applications, and establish standardized protocols for its integration into MSD management.

Introduction: Numerous studies have evaluated urologic and aesthetic outcomes of genital gender affirming surgery. However, minimal data exist on sexual function of transmasculine individuals after genital gender affirming surgery, and studies often aggregate outcomes from different techniques. This paper aims to systematically review the literature on sexual health outcomes following metoidioplasty surgery.

Objectives: To synthesize and analyze the literature on sexual health following metoidioplasty, to identify areas of further investigation, and to improve shared decision making and sexual outcomes following metoidioplasty.

Methods: Studies were systematically identified using PubMed, Embase, and Web of Science from database origins through July 30, 2025, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Included sexual health outcomes were desire/arousal, sensation, orgasm, masturbation, erection, penetrative capacity, sexual activity, and sexual satisfaction. Studies were screened independently by two authors and reviewed by four authors for eligibility. Disagreements were decided between three authors, including a sexual health expert and a gender affirming surgeon. Quality assessment was done using the Newcastle-Ottawa Scale.

Results: Twenty-three papers met inclusion criteria. All studies used ad-hoc questionnaires, and the majority did not primarily assess sexual health. Arousal/desire, preservation of erogenous sensation, and masturbation received high ratings (85+%). Erectile function scores were high (94+%), despite one outlier study (20%). Orgasm outcomes were mixed (66%-100%). Ability for penetrative intercourse was generally low (0%-24%), with one outlier study (70%). Overall sexual satisfaction was moderate-high (53%-88%).

Conclusions: Metoidioplasty appears to have largely satisfactory sexual health outcomes if penetrative sex is not a priority. Potential areas of further research include phallus lengthening protocols, PDE5 inhibitors (eg, Viagra), intracavernosal injections, and insertion of penile prostheses. Future studies are needed that include larger populations, are transparent regarding selection criteria and baseline anatomy, use standardized outcome measures, and investigate these complex outcomes from a person-centered, holistic approach.

Introduction: Genitourinary syndrome of menopause (GSM) encompasses a cluster of sexual symptoms like dyspareunia associated with genital and urinary symptoms like urinary urgency, which may be variably reported in the clinical setting.

Objectives: To provide a comprehensive guide for healthcare professionals (HCPs) in sexual medicine, helping them effectively recognize and manage GSM, a very common chronic and progressive condition with an impact on quality of life and intimate relationships.

Methods: An expert committee, invited from seven countries by the 5th International Consultation on Sexual Medicine (ICSM), was comprised of eight researchers and clinicians with expertise in menopause medicine, for the purpose of reviewing and grading the scientific evidence on nosology, etiology, diagnosis, and treatment of GSM.

Results: Presence of at least one GSM symptom ranges from 14% to 87% in postmenopausal women, with vaginal dryness and dyspareunia being the two most common symptoms. A summary of the recommendations on GSM management deriving from the evaluation of data, subject to its quality published in the scientific literature, is provided.

Conclusions: GSM is a relatively new disorder with an expanded definition to further the older long-recognized condition of vulvovaginal atrophy (VVA) in postmenopausal women to include urinary symptoms and anchor the disorder to menopause and the hypoestrogenic state. This new disorder has provided renewed incentives to formalize a significant amount of multidisciplinary research in the last decade. However, many areas ranging from epidemiology to tailored effective and safe treatment options in clinical practice still require in-depth additional investigations.

Introduction: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD), a sensory hyperactivity condition, involves a broad range of undesired, unrelenting dysesthesia(s), including genital arousal, hard flaccid syndrome, and sleep-related prolonged erection. PGAD/GPD is associated with significant, negative psychosocial consequences, including suicidal ideation. In 2021, the International Society for the Study of Women's Sexual Health developed a process of care for biopsychosocial management of PGAD/GPD in women. This article reviews the management of PGAD/GPD in all genders.

Objectives: A consensus guideline for management of PGAD/GPD in all genders was developed based on the understanding that this complex condition may be triggered by multiple pathophysiologic factors.

Methods: The International Consultation for Sexual Medicine identified co-chairs to organize a consensus committee on PGAD/GPD and select an expert multidisciplinary panel. They reviewed literature, basic science, and clinical data, using a modified Delphi method to reach a consensus on the background, diagnostic procedures, and therapeutic options.

Results: PGAD/GPD occurs in women and men with similar prevalences, from which we can infer that a substantial number of individuals are adversely affected by PGAD/GPD. While sensory hyperactivity is perceived as located in the genito-pelvic region, symptoms can originate from any of 5 regions: region 1, the end organ; region 2, the pelvis/perineum; region 3, the cauda equina; region 4, the spinal cord; and region 5, the brain. The experts reviewed region-based pathophysiologic triggers, diagnostic procedures, and biopsychosocial treatment strategies based on the location of the trigger(s). Psychological and medical treatments should be performed concomitantly.

Conclusion: Although PGAD/GPD is associated with significant morbidity, it is still underrecognized by healthcare practitioners. It is strongly recommended that individuals of all genders be safely and effectively managed following the process-of-care diagnostic algorithm that systematically examines the 5 regions to localize the dysesthesia trigger(s). The algorithm emphasizes using psychological and medical interventions in parallel throughout the process, with interventions based on the location(s) of the identified trigger(s).

Introduction: The lower urinary tract injury, although often not life-threatening, can result in devastating long-term morbidity and, in some cases, permanent disability. Male genital trauma adversely affects male sexual function.

Aim: This 5th International Consultation on Sexual Medicine guideline on male genitalia trauma evaluates urologic trauma literature to guide clinicians in the best-evidenced management with specific emphasis on preservation and optimization of male sexual function.

Methods: A systematic literature search was conducted to identify relevant English-language publications and contemporary guidelines using the PubMed database (search dates January 1, 1990 to June 1, 2024) on the following terms: "trauma," "penis," "urethra," "testis," and "scrotum." The available literature was discussed, and selected articles with the highest evidence available were used to create consensus guideline statements, categorized based on the Grading of Recommendations Assessment, Development and Evaluation system. In the absence of sufficient evidence, additional information was provided as a Clinical Principle or Expert Opinion.

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

Conclusions: Treating clinicians should be mindful that both the male genitalia trauma itself and treatment outcomes invariably affect various male sexual functions. Optimal treatment of male genitalia trauma is essential and should incorporate patient tolerances, needs, and preferences to minimize long-term sexual dysfunction.