Sexual medicine reviews最新文献

Introduction: Erectile dysfunction (ED) and cardiovascular disease (CVD) share common pathophysiological mechanisms and molecular pathways, with ED serving as an independent risk factor and prognostic marker for CVD.

Objectives: This review aims to explore the relationship between ED and CVD, analyze their shared pathophysiological mechanisms, and discuss the implications of these findings for clinical practice.

Methods: A comprehensive literature review was conducted using PubMed, MEDLINE, and Web of Science databases, with keywords including "erectile dysfunction," "cardiovascular disease," "endothelial dysfunction," "inflammation," "oxidative stress," "NO/cGMP/PKG signaling pathway," "RhoA/ROCK pathway," and "testosterone deficiency."

Results: The study found a positive correlation between ED and the incidence rate and severity of CVD, with shared mechanisms such as endothelial dysfunction, oxidative stress, and systemic inflammation. Mendelian randomization studies provided evidence of a causal relationship between genetically predicted CVD and ED risk, although reverse causality remains less clear. Early detection of ED may help prevent and manage CVD, with ED serving as a sentinel marker for asymptomatic coronary artery disease. The review also highlighted the potential of combining treatments like phosphodiesterase type 5 inhibitors with rho-associated protein kinase inhibitors or glucagon-like peptide-1 receptor agonists with testosterone therapy to optimize both cardiovascular and sexual outcomes.

Conclusions: Understanding the association between ED and CVD is crucial for improving patients' quality of life and cardiovascular prognosis. Future research should focus on elucidating the mechanistic pathways underlying ED and CVD, validating causal relationships through long-term, multimodal studies, and developing standardized risk algorithms for early intervention. For clinical practice, proactive ED screening in high-risk populations and interdisciplinary collaboration between cardiologists and urologists are essential to prevent CVD progression and enhance patient quality of life.

Introduction: Erectile dysfunction (ED) is a common male sexual disorder that diminishes quality of life significantly. Despite extensive research, little is known about the complex physiological mechanisms of ED, in part owing to disparities between animal and human physiology. Comprehensive and objective assessment methods for animal models are crucial to bridge this translational gap.

Objectives: Various experimental approaches for evaluating erectile function in rodent models are explored.

Methods: A search of the medical literature was carried out in PubMed and Medline, focusing on original research and systematic reviews of original research on the evaluation of erectile function in experimental animals. Studies without erectile assessment methods or insufficient data, editorials, letters, commentaries, and non-English articles were excluded.

Results: The ICP-to-mean arterial pressure ratio remains a valuable indicator for evaluating erectile function. Furthermore, laser speckle blood perfusion imaging technology offers an approach for assessing changes in cavernous blood flow, whereas infrared thermal imaging technology enables real-time temperature monitoring during erectile responses. Microscopic ultrasound and magnetic resonance imaging allow high-resolution observation of hemodynamic and histological changes in the rat model penis, real-time assessment of blood flow, and detailed anatomical information. Human-rat homologous marker detection using blood tests has high clinical relevance and translational potential. In addition, wearable adaptive penile rigidity monitoring (WARM) dynamically monitors erectile function by accurately and continuously detecting changes in the girth of the rat penis in a non-invasive manner. Utilizing ex vivo models of cavernous tissue, such as the cavernous artery and smooth muscle, can provide valuable insights into the mechanisms underlying ED and the pharmacological effects and efficacy of drugs.

Conclusion: This comprehensive review covers diverse approaches, including new technologies, for assessing erectile function in rodent models, including new technologies. By addressing the limitations of the existing methodologies and providing a framework for accurate and reliable evaluations, this review provides a basis for further research on the pathophysiology of ED and potential therapeutic interventions.

Background: The labia minora, an essential yet understudied component of female genital anatomy, has been hypothesized to play a role in the female sexual function. Despite its potential importance, empirical evidence linking the labia minora's anatomical characteristics to sexual function remains limited.

Aim: Through critically assessing the current literature on the labia minora, this scoping review aims to consolidate existing research on the labia minora's anatomy, vascularization, innervation, and its role in female sexual function.

Methods: Scoping review methods according to (PRISMA-ScR) were followed. A comprehensive literature search was conducted across multiple databases, including PubMed, Web of Science, and Scopus, from database inception to March 31, 2024. Studies were screened for original research on anatomy, vascularization, innervation, and sexual function of the labia minora, and data were extracted from those meeting the inclusion criteria. The quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the JBI Critical Appraisal Tool.

Results: Of the 480 studies identified, a total of 27 studies met the inclusion criteria, with the majority (56%) rated as "good" quality evidence. The labia minora was consistently found to have rich vascularization and a high density of nerve endings, suggesting a role in sexual arousal and engorgement. However, significant variations in labial morphology were noted, and the impact of these variations on sexual function remains unclear. Additionally, the role of hormonal influences, particularly androgens, on labial anatomy and function is poorly understood.Conclusion: The labia minora likely plays a critical role in female sexual function, yet many aspects of its anatomy and function are not well understood. Future research should prioritize detailed studies of its vascular and neural structures and the effects of hormonal changes to improve clinical outcomes and therapeutic interventions for vulvar-related conditions.

Introduction: Sexual dysfunction in men and women is an important clinical issue; infection and inflammation can cause social, medical, and psychological problems that have a profound impact on sexual and reproductive health worldwide.

Objectives: We set out to identify sexual dysfunctions in men and women that arise from infection and inflammation and propose meaningful interventions, as evaluated by the Fifth International Consultation on Sexual Medicine (ICSM) held in June 2024 in Madrid (Spain).

Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for published peer-reviewed journal articles and ClinicalTrials.gov and the World Health Organization's (WHO's) International Clinical Trials Registry Platform for prospective trials. This manuscript represents the opinions of 10 experts from 6 countries developed in a consensus process after completing the literature review, which produced a list of recommendations graded as weak or strong. This document was presented for peer review and debate in a public forum, and revisions were made based on the recommendations of chairpersons of the 5th ICSM.

Results: Infections, and in particular sexually transmitted infections (STIs), dramatically affect the sexual and reproductive health of individuals and couples, irrespective of sexual orientation and gender. Similarly, non-communicable chronic diseases (NCDs), through the common pathogenetic mechanism of inflammation, can directly impair the ability to copulate, reproduce, and enjoy sexual life.

Conclusions: This expert consensus recommends prioritizing early detection, comprehensive treatment approaches, and preventive measures to mitigate the effects of infection and inflammation on sexual health, both for the patient and the couple. These insights provide a foundation for improving patient outcomes and fostering global awareness of the interconnections between infection, inflammation, and sexual dysfunction.

Introduction: Misconceptions about testosterone therapy are prevalent and there is an unmet need for a review of current literature that can be leveraged by physicians to deliver safe and effective care for men with hypogonadism.

Objectives: This review aims to address common misconceptions about testosterone therapy using current literature and synthesize practical guidance for clinicians with patients who are starting testosterone therapy.

Methods: A literature search of PubMed, Embase, CINAHL was carried out to identify associations between testosterone therapy and prostate cancer, cardiovascular risk, and hepatic toxicity; definitions of hypogonadism; and practical guidance for clinician with patients starting testosterone therapy.

Results: There is no evidence to support the misconception that testosterone therapy leads to or promotes progression of prostate cancer, no evidence that testosterone therapy increases cardiovascular risk, no evidence that newer oral testosterone therapy formulations (eg, testosterone undecanoate) are associated with hepatic toxicity, and no consistent definition of hypogonadism among regulatory agencies and expert bodies. Clinicians should diagnose hypogonadism using testosterone concentrations and/or symptoms of testosterone deficiency, help patients select a testosterone therapy formulation that best fits their needs and preferences (including considerations for dose adjustment), ensure appropriate laboratory monitoring before and during treatment, and assess how patients are feeling during treatment.

Conclusions: Testosterone therapy is not associated with increased prostate cancer or increased cardiovascular risk, newer oral testosterone therapy formulations are not associated with hepatic toxicity, and a strict definition of hypogonadism is difficult because patient individualization is required. Each patient in real-world clinical practices has unique baseline characteristics and will likely respond differently to testosterone therapy. As the primary goal of testosterone therapy is to provide relief from symptoms of hypogonadism, physicians should work with their male patients to create a comprehensive treatment plan that suits the patient's specific needs and preferences.

Introduction: Disorders of ejaculation and orgasm (DEO) in men are poorly understood and can pose a substantial burden to men and their sexual partners.

Objectives: Under the aegis of the International Consultation on Sexual Medicine, a multinational, multidisciplinary panel of experts was convened to review the world literature and generate a consensus on management of DEO in men. This document represents a summary of the panel's report on physiology of ejaculation and orgasm, mental health conditions, and specific DEO that are not related to the timing of climax (ie, premature and delayed ejaculation).

Methods: Narrative review of existing literature and consensus recommendations from the expert panel.

Results: The processes of ejaculation and orgasm are complex and include neuronal and hormonal factors as well as psychological and interpersonal dynamics. Care of the patient presenting with a potential DEO centers on sensitive history taking and selective testing. Declines in semen volume may occur naturally with age and can be seen in the context of medical or surgical therapies. Pain with ejaculation/orgasm has a myriad of potential etiologies and may be part of a complex chronic pelvic pain syndrome; assessment for related diagnoses that may be contributory is warranted. Hematospermia can be distressing but is often benign; management when indicated is geared toward detecting potentially reversible etiologies. Climacturia is a troublesome condition of urine loss common after prostate surgeries; Behavioral and physical therapy and surgical intervention may be of value in these cases. Management strategies for anhedonic orgasm and post-orgasmic illness syndrome are not well established. Dhat is a complex syndrome oftentimes centered around pathological fear of semen loss that is best managed with a sensitive and culturally appropriate focus.

Conclusions: An understanding of the processes of ejaculation and what is known about DEO can aid clinicians and researchers in providing optimal care.

Introduction: Sexual activity produces pleasure related to sexual arousal, desire, and genitosensory and erogenous stimulation. Orgasms produce a whole brain and body rush of ecstatic pleasure followed by relaxation and refractoriness. This pleasure results from the activation of neurochemical reward pathways in the brain. This is differentiated by spinal pathways that control climax, the particular motor movements of the pelvic floor and the experience of tension release.

Objectives: To relate the activation of key neurochemical reward and bonding systems, notably dopamine, oxytocin, and opioids, to the pleasure of sexual activity in general and orgasms in particular.

Methods: A narrative review of the neurochemical and neuroanatomical mechanisms activated during sexual stimulation and orgasm in rats and humans, and how they are related overall to the generation of sexual pleasure and reward.

Results: Appetitive sexual pleasure involves the activation of dopamine and oxytocin release in hypothalamic and mesolimbic regions that regulate sexual arousal and desire, and are reinforced by localized opioid activity. Orgasms are thought to result in part from a massive release of opioids into these regions that inhibits dopamine and oxytocin transmission, but that initiates molecular changes to sensitize both systems and induce sexually conditioned place and partner preferences. Serotonin is also activated at orgasm and contributes to feelings of satiety and refractoriness. Orgasm disorders are distressing, cause resentment and conflict in a relationship, and diminish overall sexual health and well-being.

Conclusions: Orgasms are an important component of sexual pleasure for humans and perhaps all vertebrates. Endogenous opioids like β-endorphin that bind to mu opioid receptors are likely responsible for sexual pleasure and reward.

Introduction: Female sexual dysfunction (FSD) affects quality of life, presenting as reduced sexual desire, arousal issues, pain, and orgasm difficulties. Its multifactorial causes include physical and psychological factors, with about 43% of women in the United States affected.

Objective: To evaluate the efficacy of physiotherapy compared to other treatments (medical, psychological, pharmacological) in improving sexual function and quality of life in adult women with sexual dysfunction, excluding menopausal women. It synthesizes evidence on physiotherapeutic treatments, such as pelvic floor exercises, manual therapy, biofeedback, electrotherapy, and pelvic function education.

Methods: Following PRISMA guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science. Inclusion criteria encompassed studies evaluating the effectiveness of physiotherapy in adult women with sexual dysfunction, excluding postmenopausal. Data extraction and quality assessment were performed using standardized tools.

Results: Of the 708 identified studies, 8 met the inclusion criteria. The studies demonstrated significant improvements in Female Sexual Function Index (FSFI) domains following physiotherapeutic interventions, notably reducing pain and enhancing desire and arousal. However, heterogeneity among studies precluded meta-analysis, necessitating qualitative synthesis.

Discussion: Physiotherapy, particularly pelvic floor muscle training and multimodal approaches, proved effective in enhancing sexual function and reducing pain. While physiotherapy offers a non-invasive alternative with fewer side effects compared to surgical options, variability in intervention protocols indicates the need for standardization. Psychological and emotional factors are key in sexual dysfunction, highlighting the value of integrated treatments. Capacitive resistive monopolar radiofrequency with manual therapy improved sexual function in women with dyspareunia, though benefits were short-lived, underscoring the need for maintenance strategies.

Conclusions: Physiotherapy is an effective intervention for FSD, significantly improving quality of life. Incorporating physiotherapy into clinical rehabilitation programs is recommended. Further research with standardized protocols and long-term follow-ups is necessary to consolidate evidence and optimize treatment strategies.

Introduction: Sexual health concerns are common and significantly impact quality of life, but many people do not seek treatment due to embarrassment and other barriers. A biopsychosocial model of assessment and treatment acknowledges the biological, psychological, and social contributors to sexual difficulties and suggests that all these domains should be evaluated.

Objectives: This paper provides an overview of the major psychological factors contributing to sexual difficulties and offer an evidence-based approach for primary care clinicians to assess and treat these issues.

Methods: A comprehensive literature review was undertaken focusing on articles published since the last consultation in 2016. The study findings were synthesized, critiqued, authors assigned a Grading of Recommendation as Weak or Strong following a year-long process of discussions among the committee. When a particular well-established psychological practice was not evaluated in the literature, we assigned an expert opinion recommendation.

Results: Since the 2015 ICSM, there have been a number of high-quality trials of psychological treatments addressing sexual dysfunctions, as well as meta-analyses and systematic reviews. In some domains, there is strong evidence of psychological treatment, and primary care providers should be aware of such approaches and refer when appropriate.

Conclusions: This paper offers a practical guide for primary care clinicians to understand the psychological factors underlying sexual dysfunction and outlining what approaches may be appropriate for this clinician, and when the patient should be referred to a specialist. We emphasize an evidence-based approach to managing sexual dysfunctions in primary care, allowing for timely interventions. A comprehensive evaluation of biopsychosocial factors is recommended to personalize psychological interventions to overall context, including chronic diseases, mental health issues, and relationship conflicts. The initial assessment is key to developing an individualized intervention plan, which may include psychoeducation, referral for cognitive-behavioral therapy, mindfulness, or couple therapy, and consideration of medical or digital health interventions.