Sexual medicine reviews最新文献

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: 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.

Introduction: Erectile dysfunction (ED) is a highly prevalent male sexual disorders, affecting million of men worldwide. Given the volume of literature in ED, bibliometric analyses will provide an important resource to highlight landmark articles.

Objectives: To evaluate the publication trends and impacts between basic scientific research and clinical studies through bibliometric analysis of ED literature between 1998 and 2023.

Methods: We searched for articles in the Web of Science database from 1 January 1998 to 31 December 2023 using MeSH terms specific to ED. Relevant articles were divided into basic scientific research and clinical studies. A bibliometric analysis was performed by using "Citespace" and "VOSviewer" software.

Results: A total of 6450 studies were identified, with 4808 in clinical studies and 1642 basic scientific research. The USA has the highest publication rate with 1851 articles, followed by China (853) and Italy (635). The University of California, San Francisco ranked first in basic scientific research with 68 research papers, while the University of Florence led the clinical research with 133 papers. The Journal of Sexual Medicine and the Journal of Urology were found to have the highest academic influence. Clinical research papers receive more citations than basic scientific ones. Notably, vardenafil emerged as the most frequently used keyword in ED research over the past decade, ranking first in both basic scientific and clinical studies.

Conclusion: Bibliometric analyses can provide an in-depth analysis in distinguishing ED literature. There is a need to foster multi-center international collaborations and new emphasis on novel technology and recent scientific advances.

Introduction: The sexual response, including sexual desire and arousal/penile erection in men, is affected by several hormones and neurotransmitters.

Objectives: To give resources to understand the usefulness to assess different hormones when considering a man with hypoactive sexual desire or erectile dysfunction and to provide evidence-based recommendations for clinical practice. A level of evidence grading system was used to provide strong, moderate, or conditional recommendations.

Methods: An extensive revision of the scientific literature was performed by the subcommittee of the International Consultation of Sexual Medicine. The results were first extensively discussed by the sub-committee members and presented publicly for further discussion with other experts. The roles of hypothalamic (kisspeptin, α-melanocyte-stimulating hormone), pituitary (prolactin, oxytocin [OT], and growth hormone), thyroid, adrenal (dehydroepiandrosterone, glucocorticoids, and mineralocorticoids) and sex hormones were considered.

Results: Testosterone has a primary role in controlling and coordinating male sexual desire and arousal, acting at multiple levels. Accordingly, meta-analysis indicates that testosterone therapy for hypogonadal individuals can improve low desire and erectile dysfunction. Hyperprolactinemia is associated with low desire which can be successfully corrected by appropriate treatments. OT, α-melanocyte-stimulating hormone, and kisspeptin are important in eliciting sexual arousal; however, the use of these peptides or their analogs, for stimulating sexual arousal is still under investigation. Evaluation and treatment of other endocrine disorders are suggested only in selected cases.

Conclusions: Endocrine abnormalities are common in patients with sexual dysfunction. The identification of some of these is mandatory (ie, testosterone, prolactin), whereas, for others, it is known that their disorders may cause sexual dysfunction without, however, being frequently recognized in subjects consulting for sexual dysfunction (ie, thyroid and growth hormones). Others may be important, but the clinical use is limited by issues with their measurement (ie, estradiol, dihydrotestosterone), whereas for some hormones or neuropeptides, the clinical usefulness for diagnostic and/or therapeutic purposes should still be established.

Introduction: Preserving erogenous sensation is essential for postoperative sexual function and patient satisfaction following gender-affirming surgery. However, the biological basis of erogenous sensation and its assessment methods are not well understood.

Objective: This review summarizes the current mechanistic understanding of erogenous sensation and identifies existing knowledge gaps for future research.

Methods: Three databases were queried from their inception to December 2022 for full-text English articles investigating erogenous sensation. Two independent reviewers screened the studies, and key results were extracted. The findings were compiled to discuss erogenous sensation, organized into neurophysiologic mechanisms, assessment modalities, and the sensibility of different erogenous territories.

Results: Of the 143 included studies, 46 (32%) articles investigated the physiology of erogenous sensation. Of those, 13 (28%) studies focused on the brain regions involved in processing erogenous sensations. Most studies (92 [64%]) assessed erogenous sensation following a procedure. Among this group, 53 (58%) studies relied only on subjective patient-reported outcomes (ie, survey, visual analog scale, etc.). Only 22 (24%) studies used objective assessment modalities such as vibrotactile detection thresholds and vaginal photoplethysmography.

Conclusion: Significant gaps remain in the understanding and assessment of erogenous sensation. Current research is limited by methodological inconsistencies and a lack of standardized, objective measurement tools. Future efforts should prioritize developing validated assessment methods and conducting longitudinal studies to enhance sensory outcome evaluation in gender-affirming surgery.

Introduction: Since its proposal in 2002, late-onset hypogonadism (LOH) has been a subject of considerable controversy. Although its status as a pathophysiological entity is undisputed, the underlying mechanisms remain contentious and are not fully understood.

Objectives: To evaluate current therapies for LOH, such as testosterone replacement therapy (TRT) and weight loss interventions, and to explore innovative anti-aging strategies aimed at counteracting age-related factors contributing to LOH.

Methods: A comprehensive literature review was conducted to explore the ongoing controversies and challenges in the clinical diagnosis of LOH. Additionally, the efficacy and limitations of current therapeutic approaches, including novel anti-aging strategies and combination therapies were critically examined.

Results: Current therapies address specific aspects of LOH, such as TRT for low testosterone levels and weight loss interventions for obesity, which is the strongest risk factor. However, these therapies have shortcomings, including potential health hazards associated with TRT and disputed efficacy of weight loss interventions. Recent discoveries have led to the development of innovative anti-aging strategies, which show promise in overcoming the limitations of existing methods. Several clinical trials have substantiated the efficacy of these novel approaches, particularly when used in combination therapies.

Conclusions: While further clinical trials are necessary, novel anti-aging strategies hold promise for enhancing the efficacy of existing LOH treatments and overcoming their limitations. These innovative approaches could potentially offer more effective solutions for managing LOH.

Introduction: The purported predominance of the biopsychosocial model is reviewed, including its underlying factors that determine the etiology and treatment of sexual disorders. We recommend that sexual health professionals embrace a broader recognition of all facets of the model. Periodic re-examination is necessary to optimize its strengths and minimize misapplication.

Objectives: Improving the application of the full scope of the biopsychosocial model will help ensure that it remains robust and inclusive. Awareness of its limitations should prompt clinicians to expand their knowledge through continuing education.

Methods: Co-authors reviewed database searches, including PubMed, Google Scholar, and ClinicalTrials.gov. Publications, sexual society presentations, and guidelines were also considered, along with expert opinions. Authored by an intentionally recruited, diverse group of experts representing different disciplines, geographic regions, genders, and perspectives, our manuscript deserves substantial consideration. However, this work does not employ the rigorous methodology used by professional societies in producing guidelines.

Results: The biopsychosocial model is widely used; however, too many sex therapists and sexual medicine experts claim to adopt the model while merely paying it lip service. Clinicians support multidisciplinary approaches, yet siloed thinking persists. Collegial respect is increasing, but perspectives remain divided. While sex therapists recognize psychosocial nuances, many are unaware of biomedical advances in diagnosis and treatment that impact sexuality. Conversely, many physicians lack sufficient awareness of the cognitive, emotional, behavioral, and cultural factors contributing to sexual disorders. Physicians who prefer broader assessments often find that time constraints in clinical practice hinder multilayered engagement.

Conclusion: The biopsychosocial model must encompass all predisposing, precipitating, and maintaining biological, medical/surgical, cognitive, behavioral, emotional, social, and cultural factors involved in the etiology and management of sexual disorders. Etiology is best understood at a granular level that acknowledges multiple proportional contributing factors. We recommend that clinicians across disciplines increase their awareness of all relevant etiologic and treatment factors while continuing to use the accessible term "biopsychosocial."