Sexual medicine reviews最新文献

Introduction: Nocturnal emissions (NEs), or "wet dreams," are involuntary ejaculations occurring during sleep. Although NEs are a normal component of male puberty, uncertainties have persisted regarding their physiology, epidemiology, and clinical significance.

Objectives: To systematically review the literature on NEs, summarizing epidemiological data, physiological mechanisms, cultural perspectives, and clinical relevance.

Methods: A systematic search of PubMed and EMBASE (from inception to April 2025) was performed. Grey literature was included to minimize publication bias, and non-English studies were translated. The FAERS and EudraVigilance databases were queried for drug-related NEs. No exclusions were made based on study design. The risk of bias was assessed with the Newcastle-Ottawa Scale, and qualitative works were appraised narratively.

Results: A total of 157 sources were included. The first NE typically occurs between 12.6 and 15.6 years, most often at 13-14, with modest cross-cultural variation. Prevalence resulted high (70%-90%), especially among adolescents, though lower in some Asian cohorts and rare in individuals with neurological impairment. Data on frequency were scarce and inconsistent. Educational gaps were evident and misconceptions remain widespread, particularly in South Asia, where NEs are central to Dhat syndrome. Evidence did not support the historical view of NEs as a compensatory release under conditions of low sexual outlet. NEs occurred with or without erotic dreams. Findings from studies on spinal cord injury and psychogenic anejaculation confirm that they can arise independently of supraspinal control. Their association with sleep orgasms and sleep-related erections remained uncertain. Hormonal, parental, and prenatal influences appeared modest. NEs may help in differentiating psychogenic anejaculation and occasionally serve as a sperm source for assisted reproduction.

Conclusion: NEs are a nearly universal, physiological phenomenon with cultural, educational, and clinical dimensions and they remain relevant to sexual development, adolescent health, and certain diagnostic contexts. High-quality prospective research is needed to clarify mechanisms and implications.

Introduction: Erectile dysfunction (ED) is a prevalent condition commonly seen by urologists, significantly affecting the sexual health of many patients. Although phosphodiesterase-5 inhibitors (PDE5Is) remain the only FDA-approved treatment for ED, there are several experimental pharmacological targets under investigation that may benefit patients unresponsive to PDE5Is.

Objectives: This review aims to identify alternative pharmacological targets to phosphodiesterase-5 for treating ED and explore the biochemical mechanisms that regulate these targets to develop future therapeutics.

Methods: A literature search was conducted on PubMed to synthesize information from various sources into this review. Keywords and phrases were searched in PubMed including "erectile dysfunction," "nitric oxide," "Rho-kinase pathway," "JAK-STAT pathway," and "alternative targets to phosphodiesterase-5." Studies more recently published were prioritized to account for clinical relevance, and information was cross-checked with numerous peer-reviewed articles to support credibility and reliability.

Results: Promising emerging pathways and mechanisms for ED treatment are rising to clinical prominence, including the Rho-kinase and JAK-STAT pathways, nitric oxide and dopamine neurotransmitters, and calcium-regulated ion channels. These alternative targets offer potential for managing ED, particularly in cases where comorbid conditions like cardiovascular disease and diabetes are present.

Conclusion: The interplay between these pathways and related diagnoses underscores the potential for developing innovative and effective ED therapies for urologists to apply in the clinical environment. Notably, nitric oxide and the Rho-kinase pathway have surfaced as leading alternatives to PDE5Is, introducing new strategies for enhancing erectile function through unique biochemical processes.

Introduction: The cavernous nerves are constitutive elements of the intrapelvic autonomic neuroregulatory input to the penis and pelvic floor, serving principally to mediate penile erection and likely urinary continence to some extent. Diffuse and variable in their topography surrounding the prostate, these neural structures are challenging for surgeons to discern and avoid injuring during radical prostatectomy, despite the use of modern surgical maneuvers for cavernous nerve preservation. Accordingly, objectives of patient retention of erectile function after surgery are insufficiently met.

Objectives: This narrative review aims to present the evolutionary understanding of the detailed complex anatomy of the cavernous nerves and to appraise innovative methodologies that have been proposed for mapping cavernous nerves and monitoring their functional integrity intraoperatively during radical prostatectomy.

Methods: A non-systematic literature search was conducted to identify published literature pertaining to cavernous nerve anatomy and physiology with relevance to pelvic surgery, with particular focus on literature describing techniques and technologies for preserving cavernous nerves during radical prostatectomy.

Results: The cavernous nerves represent a complex distribution of nerve fibers extending from the network of nerves surrounding the prostate that course to the proximal corpora cavernosa as well as to adjacent structures in the region of the pelvic floor. Their topography is diffuse and individually distinct across patients, with a precise portion that is active in producing penile erection. Cavernous nerve localization methods are being developed for real-time visualization of functionally active periprostatic erectogenic nerves during radical prostatectomy. Neurophysiological monitoring methods are also in development that guide the surgeon to avoid cavernous nerve injury when executing radical prostatectomy.

Conclusions: Improved functional recovery outcomes after radical prostatectomy can be expected with the advancement of intraoperative cavernous nerve mapping and real-time functional monitoring methodologies.

Introduction: This is the first International Consultation on Sexual Medicine (ICSM) position paper on sexual health in older adults. Physical, cognitive, and psychosocial factors create a unique set of challenges related to sexuality in older adults.

Objectives: This study explores the impact of the physiological aspects of aging, state of health, psychological, relationship-related, and sociocultural factors, on sexual health in older adults. The goal of this review is to provide recommendations for the comprehensive evaluation and treatment of this population.

Methods: A narrative review was conducted under the auspices of the ICSM, as part of its ongoing efforts to develop expert, evidence-based guidance in the field of sexual health. A multidisciplinary panel of international experts composed of specialists in urology, gynecology, psychiatry, sexual medicine, social work, and sex therapy was convened. A comprehensive literature review was conducted based on a search of psychological sources (PsycInfo), medical databases (PubMed, Medline), and Google Scholar. All retrieved articles were reviewed and critically assessed. Recommendations were then formulated using a modified Delphi method.

Results: Although there is extensive literature on the prevalence and risk of sexual challenges of adults over the age of 65, there is limited evidence regarding the quality of treatment modalities. In particular, there is scant data on women in this age group. This population faces specific and multifactorial challenges, which point to the need for a comprehensive approach to their care.

Conclusion: Any approach to sexual health in older adults needs to take all the factors that affect sexual health into account, while endorsing the full spectrum of sexual expression in a non-judgmental way. Individuals in a relationship should be offered a couple-centered approach. Special attention is needed for individuals in cognitive decline. Healthcare providers must be aware of ageist biases, which may prevent them from providing appropriate care.

Introduction: Orgasm experience is associated with greater sexual and relational well-being within couples' relationships. In the context of a partnered sexual relationship, this dimension of the sexual response has been mainly studied from an individualistic perspective, with few studies adopting a dyadic approach.

Objectives: This scoping review aims to review and synthesize the literature that has examined orgasm as a predictor of sexual and relational well-being in dyadic contexts.

Methods: Following the Preferred Reported Items for Systematic Reviews and Meta-Analyses-Scoping Review guidelines, a database search was conducted on EBSCOhost, Web of Science, Scopus, PubMed, and SciELO databases using key terms related to "orgasm" and "dyadic."

Results: A total of 280 articles were identified, and 9 fulfilled eligibility criteria and were included in this review. All studies sampled couples using a dyadic design. All studies employed cross-sectional designs and predominantly reflected different-gender/sex heterosexual couples, and all participants were cisgender. Findings showed that orgasm is consistently linked to both sexual and relational well-being in dyadic contexts. Orgasm frequency and its subjective experiences were associated with individual and partner sexual satisfaction, with some effects mediated by sexual communication. Relational outcomes were also shaped by the importance attributed to orgasm and by the (mis)perception of the partner's orgasm. Notably, gendered patterns emerged, particularly within different-gender/sex couples, highlighting the centrality of women's orgasm in shaping both partners' wellbeing.

Conclusions: Future research might focus on orgasm as a dyadic experience, include individuals with diverse gender identities and sexual orientations, and adopt daily-diary designs to capture the unique orgasm experiences as they unfold in couples' daily lives.

Introduction: There is no ideal treatment for Peyronie's Disease (PD) since every patient has different needs with varying perceived risks versus benefits of individual treatment options, coupled with the degree of impact relating to PD on sexual function and beyond.

Objectives: The 5th International Consultation on Sexual Medicine (ICSM) guideline on PD provides an update to the previous ICSM with an aim to provide a clinical framework and best-evidenced consensus recommendations to assist clinicians in managing PD.

Methodology: Available literature was reviewed, and a modified Delphi consensus was undertaken by leading sexual medicine experts to achieve a set of Quality of Evidence and strength of recommendations. This guideline was developed as an authoritative best-evidenced consensus incorporating state-of-the-art knowledge and contemporary literature.

Results: A total of thirty-one recommendations were made on PD guidelines. New updates to the 4th ICSM on PD have been made in definition, pathophysiology, and treatment strategies. The presence of penile pain with erection could occur in the chronic phase due to torque or stretch on the penile scar and surrounding tissue. Oral therapy works best during the acute phase and should be provided concurrently with other treatment modalities. Penile traction therapy can reduce penile deformity as monotherapy or may be offered as part of a multimodal therapy approach. There is no convincing evidence supporting cellular-based therapy. The type of plication procedure used depends on the surgeon and patient preference, although excision of the tunica followed by plication may have a higher complication rate. There is currently no ideal graft, and graft contracture can occur postoperatively. Adjunctive procedures such as penile modeling, tunical plication, plaque incision/excision and grafting can be performed when penile deformity and/or penile curvature persist following penile prosthesis implantation.

Conclusions: The management of PD should be individualized based on the patient's needs and preferences while balancing the benefits and risks of each treatment option.

Introduction: Infertility is a significant global health concern, particularly among individuals of reproductive age. At the same time, psychiatric disorders-especially depression and anxiety-are increasingly prevalent, leading to a growing global demand for antidepressants.

Objectives: The present review aimed to compile and analyze preclinical studies evaluating the effects of antidepressant exposure on sperm parameters and fertility outcomes in animal models.

Methods: A comprehensive literature search was conducted in April 2023 using the PubMed/Medline, Web of Science, and Scopus databases. The search strategy combined terms such as "fertility," "sperm," and "semen" with keywords related to various classes of antidepressants and their specific compounds. Eligible studies included experimental research assessing sperm and/or fertility parameters following antidepressant administration in male animals. Data extracted from the selected studies included drug class, specific compound, dosage, treatment duration, animal species, subject age, and reproductive outcomes.

Results: A total of 32 studies met the inclusion criteria. Among the antidepressants investigated, selective serotonin reuptake inhibitors were the most frequently studied, with venlafaxine, fluoxetine, and paroxetine being the most commonly evaluated compounds. Most studies reported adverse effects on sperm parameters, such as concentration, motility, and morphology. However, evidence regarding fertility outcomes remains inconclusive due to the limited number of studies and considerable heterogeneity in experimental designs and treatment protocols.

Conclusion: These findings suggest that several antidepressants may impair sperm quality in animal models, with possible implications for male fertility. Nonetheless, further research is warranted to clarify these effects, particularly for less-studied antidepressant classes.

Introduction: Peyronie's disease causes penile curvature and painful erections, potentially impairing quality of life; surgical grafts are employed to correct curvature and restore penetrative sexual function.

Objectives: This study aimed to summarize the evidence on perioperative and functional outcomes of surgical grafting procedures for Peyronie's disease.

Methods: A systematic review was conducted following the PRISMA guidelines. Databases including PubMed, EMBASE, Scopus, Google Scholar, and the Cochrane Library were searched up to April 1, 2023. Eligible studies included retrospective or prospective reports on patients aged 18 years or older treated with various graft materials, including vein, dermal, buccal mucosa, small intestinal submucosa, human cadaveric, and bovine pericardium. Quality was assessed using the JBI Critical Appraisal Checklist. Due to data heterogeneity and a lack of comparative studies, no quantitative synthesis was performed. The systematic review was registered on PROSPERO-CRD42024508997. The review focused on perioperative outcomes, erectile function changes, and complication rates associated with different graft materials.

Results: Out of 521 articles identified from 1933 to 2023, 71 studies involving 2692 patients met the inclusion criteria. Six studies were prospective, and the remainder were retrospective. Quality assessment revealed a high or severely high risk of bias across all included studies. Erectile function worsened in 0%-70% of patients, with complication rates ranging from 0% to 50%. No comparative studies among graft types were identified.

Conclusion: Various graft materials offer reliable perioperative and functional outcomes for Peyronie's disease; however, further comparative studies are essential.

Introduction: Peyronie's disease (PD) is a fibroproliferative disorder of the tunica albuginea characterized by localized plaque formation, penile curvature, and erectile dysfunction, most commonly affecting men between 40 and 70 years of age. Although François Gigot de La Peyronie is credited with the first formal description of the disease in 1743, depictions of penile curvature predate his description by millennia.

Objectives: This review aims to provide a comprehensive understanding of the historical and contemporary evolution of therapeutic strategies for PD, highlighting the shift from anecdotal remedies to evidence-based approaches.

Methods: PubMed, Cochrane, and Embase databases were searched without restrictions on publication date, using keywords related to PD and its therapies. Key interventions, including oral and topical agents, intralesional injections, penile traction therapy (PTT), and surgical techniques, were analyzed in the context of clinical trial data and guideline recommendations.

Results: Early therapeutic approaches focused on oral and topical agents, which failed to demonstrate consistent efficacy in randomized trials. Intralesional injection (ILI) therapy has emerged as a leading option for nonsurgical management, with collagenase Clostridium histolyticum (CCH) as the standard treatment supported by robust evidence of significant improvements in penile curvature. PTT has undergone considerable refinement, with second-generation devices yielding excellent outcomes, particularly when combined with CCH. Surgical intervention remains the gold standard for definitive treatment of severe or complex deformities. Technical modifications have developed, including the use of biologic grafts, inflatable prosthesis placement with manual modeling, and graftless techniques such as tunica expansion and auxetics.

Conclusion: A review of the historical progression of PD management demonstrates the shift from anecdotal claims of treatment efficacy to evidence-based practice. Current guidelines recommend ILI and PTT as first-line nonsurgical management, with surgery providing exceptional outcomes. Future progress aims to gain a greater molecular understanding of fibrosis and tissue remodeling to foster targeted therapies.