Sexual medicine reviews最新文献

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.

Introduction: Men's sexual health is an essential yet under-addressed aspect of well-being in Saudi Arabia, shaped by a complex interplay of cultural traditions, religious teachings, and stigma. While Islam encourages marital intimacy, open conversations on sexual health are obstructed by taboos and misinformation. Misconceptions about erectile dysfunction, penile size, masturbation effects, and sexual performance, fueled by pornography, uncontrolled social media, and limited education, result in poor health-seeking behaviors and incorrect use of medications.

Objectives: This article is based on clinical opinion and cultural insights of experts from Saudi Arabia and examines myths, sociocultural challenges, and treatment patterns that influence men's sexual health. A literature review was performed to identify studies and regional data to support the expert perspectives.

Methods: An unstructured literature search was conducted on PubMed, Google Scholar, and Cochrane Library without any date restrictions to ensure a thorough review of available evidence. The initial literature search was conducted in January 2025, with subsequent search in August 2025.

Results: The experts highlight barriers including limited premarital counseling, preference for non-Arab physicians, gender-specific stigma and unrealistic expectations. Recommendations from experts include integrating sexual health into medical training and religious teachings, launching culturally destigmatizing education programs, and establishing virtual sexology clinics. Experts emphasized the value of emotional planning, promoting the concept of planning for intimacy, not just intercourse in an effort to permit couples to connect and reduce anxiety. By bridging Islamic values with modern medical practice, Saudi healthcare providers can normalize sexual health discussions, improve adherence, and promote marital harmony. Collaborations among healthcare professionals, educators, religious scholars, and policymakers are essential to advance this national health priority.

Conclusion: Sexual health in Saudi Arabia is hindered by cultural stigma, misinformation, and limited access to care. A coordinated, culturally sensitive strategy integrating education, regulation, and open dialog is essential for meaningful progress.

Introduction: Vulvovaginal pain in women has been associated with a host of negative outcomes in the domains of sexual, relational, and psychosocial well-being. Despite significantly affecting racialized groups, most literature in the field has been conducted on white or European samples.

Objectives: In order to guide future research and inform clinical conceptualizations, we conducted a scoping review to document previous research priorities and establish current knowledge of vulvovaginal pain in racialized women.

Methods: In total, 17 studies were extracted and included in the review after independent title and abstract and full-text review.

Results: Results were categorized based on study aim, indicating a focus on the prevalence, nature, and experience of vulvovaginal pain in racialized women. Black women were the most represented group in this literature, followed by Hispanic women, whereas other racialized groups, like Asian, Middle Eastern, and Indigenous women, were not represented.

Conclusion: Overall, findings revealed that racialized (as compared to white) women's experiences of chronic vulvovaginal pain are distinct and often associated with worse outcomes and experiences. These results highlight the importance of accounting for social location in vulvar pain experiences. Clinical and research implications are discussed.

Introduction: Premature ejaculation (PE) is one of the most prevalent male sexual disorders, with lifelong PE (LPE) affecting ~cx3%-5% of men. While peripheral, psychological, and relational factors are well-known contributing factors, accumulating neuroimaging and electrophysiological evidence suggests central neural mechanisms, including serotonergic, dopaminergic, and other neuromodulatory pathways play a role.

Objectives: To synthesize findings from neuroimaging and electrophysiological (electroencephalography) studies, providing an integrative perspective on the neural substrates of LPE and identifying gaps for future research.

Methods: A narrative review was conducted based on 43 original studies reporting structural-, functional-, and network-level neural correlates of LPE. The literature search and selection were performed in accordance with the Scale for the Assessment of Narrative Review Articles guidelines to ensure transparency and methodological rigor. Studies were categorized by modality, and findings were qualitatively synthesized to identify convergent patterns, regional alterations, and clinical correlations.

Results: Structural neuroimaging in LPE patients consistently demonstrates altered gray matter volume, cortical thickness, and white matter microstructure in prefrontal, orbitofrontal, striatal, thalamic, limbic, and temporal regions. Functional analyses reveal reduced top-down inhibitory control from prefrontal regions, hyperconnectivity within limbic-temporal sensory circuits, and dysregulated network dynamics across cortico-striato-thalamic pathways. Electroencephalography studies indicate abnormal cortical excitability and high-beta responses in frontal and temporal regions during sexual arousal. Multimodal studies show these neural alterations correlate with clinical severity, and machine learning models achieve high accuracy in differentiating LPE patients from healthy controls.

Conclusions: LPE is associated with distributed neural network dysfunction, characterized by impaired inhibitory control, exaggerated sensory processing, and dysregulation of serotonergic, dopaminergic, and other neuromodulatory systems. Although central changes may be both a cause and a consequence of LPE, these findings primarily advance mechanistic understanding and should be considered research-level indicators rather than diagnostic biomarkers.

Introduction: Hypoactive sexual desire disorder (HSDD) is one of the most common female sexual dysfunctions.

Objectives: To produce a consensus article on the evaluation and management of HSDD.

Methods: An international committee was selected to review available data and present recommendations to the 5th International Consultation on Sexual Medicine. Discussion and revisions were made to highlight state-of-the-art knowledge based on the peer-reviewed medical literature and expertise of experts worldwide.

Results: The consensus article reviews the most up-to-date evidence for definitions of HSDD and its clinical assessment, including psychological, nonhormonal, hormonal, and alternative therapies.

Conclusion: There are many available therapies for HSDD, all of which should be utilized through a biopsychosocial approach to improving this condition.

Introduction: Disorders that affect sexual function, including vulvodynia and post-orgasmic illness syndrome (POIS), are under-reported and under-researched, leaving many patients without optimal treatment strategies. These conditions often present with inflammatory or allergic-type symptoms, such as itching, burning, and congestion. Immune system dysregulation, including mast cell (MC) dysfunction, has been proposed as a potential mechanism underlying these disorders.

Methods: A literature review was conducted on studies published from 2010 to 2025. Articles exploring the pathological, histopathological, pathophysiological, or etiological nature of vulvodynia and POIS were included. A total of 35 studies met the inclusion criteria and were analyzed to assess the role of immune responses in these disorders.

Results: The review highlighted a compelling relationship between immune factors and vulvodynia and POIS. Vulvodynia studies increasingly support a role for immune dysregulation, including altered T- and B-cell activity, elevated cytokines, MC activation, and localized immune differences. Post-orgasmic illness syndrome cases suggest an immunoallergic mechanism, particularly IgE-mediated. Yet, in both conditions, the literature reveals complex, heterogeneous pathophysiologies that are unlikely to be explained by immune mechanisms alone.

Conclusion: The etiology of sexual disorders like vulvodynia and POIS remains poorly understood. However, the reviewed literature supports the hypothesis that both of these conditions may have an immunologic component to their etiology. Further research is necessary to elucidate these mechanisms fully and to develop evidence-based treatments.

Introduction: With accumulating, strongly supportive epidemiological evidence, a new understanding has emerged of the complex interactions between psychological factors (e.g., depression) and both erectile dysfunction (ED) and ischemic heart disease (IHD) in men.

Aim: To elucidate the relationship between depression, ED, and IHD.

Method: We review recent studies on the relationship between ED, depression, and IHD. We also describe and evaluate current psychological theories related to ED onset and maintenance and consider the implications of recent large-scale studies linking ED, whether organically or psychologically based, with the presence of common, chronic diseases in men, particular IHD and depression.

Results: There is a well-documented association between depression and both the development of IHD. Longitudinal studies have shown that the presence of depression increases the incidence and risk of ED over time; conversely, successful treatment of ED has been associated with significant improvements in mood and depression scores in patients with concomitant ED and depression. Treated depression has also been shown to reduce the risk of incident IHD. The recent Princeton IV panel concluded that ED is a potential harbinger or moderator of the link between depression and IHD. Additionally, the panel concluded that there is sufficient evidence currently to support the observation that psychogenic ED is an independent risk factor for heart disease in men. These findings apply in younger and older men.

Conclusion: The studies reviewed strongly suggest the need for more collaboration between mental health and other health care practitioners. Combination therapy has repeatedly been shown to increase treatment satisfaction and compliance, sexual and relational satisfaction, and decrease discontinuation rates. Finally, we discuss the next set of challenges in mental health including the role of AI sex- or psychotherapy.

Introduction: Sexual dysfunction (SD) is a frequent and underrecognized complication of obesity, mediated by a complex interplay of hormonal, vascular, metabolic, and psychosocial pathways. Despite the established link between weight reduction and improved sexual health, the specific effects of new pharmacological weight-loss therapies on sexual function remain underexplored.

Objectives: To critically evaluate the recent evidence on the impact of weight-loss medications on sexual function, synthesizing clinical outcomes, mechanistic insights, and identifying critical research gaps.

Methods: We conducted an update and comprehensive narrative review using PubMed, Scopus and Embase databases. A systematic search strategy employed predefined terms related to obesity, SD, and pharmacotherapy. Eligible studies were those reporting sexual outcomes using validated instruments [eg, Female Sexual Function Index (FSFI), International Index of Erectile Function (IIEF)] or relevant clinical reports.

Results: GLP-1 receptor agonists show promising results in men, improving erectile function, testosterone levels, and sperm parameters. In contrast, direct evidence in women remains limited. Tirzepatide achieves unprecedented weight loss, but case reports suggest potential sexual side effects. Naltrexone/bupropion may benefit sexual desire through mood improvement, while phentermine/topiramate primarily enhances psychological well-being. Setmelanotide demonstrates the direct involvement of the melanocortin pathway in sexual function. Across all drug classes, sexual endpoints were typically secondary outcomes in clinical trials.

Conclusion: Pharmacological weight-loss therapies influence sexual health through multiple direct and indirect pathways. However, current evidence is inconsistent, and sex-specific data are scarce. Future clinical trials should systematically include validated sexual function measures as primary endpoints and stratify results by sex and comorbidities to better guide clinical practice in sexual medicine.

Introduction: Glandular tissues, including the vestibular glands, play an important role in the female genital system. Despite this acknowledgement, the detailed structure and function of the major and minor vestibular glands has yet to be comprehensively reviewed.

Objectives: Through a review of current evidence, this paper aims to consolidate current understanding of the functional anatomy, physiological significance, and suggested role in sexual function of the vestibular glands, and identify knowledge gaps to inform future research.

Methods: A comprehensive literature search was conducted using various databases. Keywords included "vestibular glands", "Bartholin's glands", and "minor vestibular glands". Original research on the anatomy, embryology, function, and pathophysiology of the vestibular glands were included for review.

Results: Limited literature focused on the embryonic development of the vestibular glands, though there is a prevailing hypothesis that they originate from the urogenital sinus. The major vestibular glands are described as oval-shaped glands and located at the posterior vaginal introitus, with ducts opening into the vulvar vestibule, though supporting anatomical data is lacking. Microscopic analyses indicate these glands produce mucin and contain neuroendocrine cells. However, data on blood supply and innervation were scarce. There is also a conspicuous lack of delineation between the major and minor vestibular glands both anatomically and functionally. Some studies linked the glands to sexual function, suggesting a role in lubrication and orgasm, though supporting evidence is limited.

Conclusions: The vestibular glands are presumed to play a role in female sexual function, though their detailed physiology remains poorly understood. While these glands are believed to aid in lubrication, significant gaps exist in understanding concerning their embryology and anatomy (eg, blood supply, innervation) remain to be addressed. Future research should prioritize detailed functional anatomical and physiological studies to better understand these glands, which may in turn help inform clinical knowledge of related disorders.

Introduction: The gut microbiota, which is recognized for its crucial role in regulating numerous physiological processes, harbors a relationship with sexual function that has remained relatively understudied.

Objectives: This narrative review aims to integrate the existing evidence regarding the association between the gut microbiota and sexual function. Additionally, it endeavors to discuss the research challenges and delineate the future directions within this burgeoning field.

Methods: A comprehensive analysis was carried out on both pre-clinical and clinical studies. The scope of the analysis encompassed: (1) the associations between the composition of the gut microbiota and various forms of sexual dysfunctions, (2) the risk factors for sexual dysfunction that are associated with alterations in the microbiota, and (3) the potential interventions that target the regulation of the gut microbiota.

Results: In the context of erectile dysfunction and hypoactive sexual desire disorder, several investigations have identified specific changes in the gut microbiota. Additionally, risk factors for sexual dysfunction, such as mental health disorders, obesity, diabetes, hypertension, and thyroid dysfunction, are also influenced by the gut microbiota. Promising intervention strategies include dietary modification, supplementation with probiotics or prebiotics, fecal microbiota transplantation, and bioengineering approaches.

Conclusion: The current body of evidence has established a link between gut microbial dysbiosis and the pathophysiology of various sexual health issues. Despite the fact that our understanding and assessment of the impact of gut microbes on the sexual function of the host are still in their infancy, continued advancements may unveil novel potential targets for the management of sexual health.