Sexual medicine reviews最新文献

Introduction: Female genital self-image (FGSI) refers to one's perception of the external and internal appearance of female genitalia. FGSI is a multidisciplinary research area influenced by psychological, sociocultural, and clinical factors, influencing sexual satisfaction, desire, self-perception, and partner perception.

Objectives: The review aims to improve doctors' understanding of genital self-image by incorporating psychological and sociocultural perspectives, thereby promoting a comprehensive and holistic approach.

Methods: A comprehensive search technique was used to obtain research papers from the following databases: PubMed (MEDLINE), Scopus, and Web of Science. Google Scholar was also manually searched. The search results were imported into Rayyan reference management and assessed using the established inclusion criteria. The quality of the articles was assessed using the appropriate JBI checklist (ie, according to the study design), and the JBI grades of recommendation were used to grade the evidence.

Results: Psychological theories like self-schema, body image, and female personal harm view offer insights into FGSI, but none provide a comprehensive explanation of subjective body image dissatisfaction.Research indicates women often experience anxiety about discussing genitalia and accepting sexual attention, but limited literature on negative self-image causes. Interventions include sexological counseling, therapy, educational programs, and public statements. Understanding FGSI is crucial for effective pre-surgical counseling, incorporating online portrayals, attitudes, and reasons for cosmetic surgery, and addressing psychological and sociocultural factors.This text delves into the intricate psychological and sociocultural factors that shape FGSI, presenting a model of intra- and interpersonal dynamics. The link between FGSI and negativism is unclear, but it is linked to women's confidence and subjectivity, with positive self-perceptions predicting higher sexual satisfaction and mental health.

Conclusions: FGSI has an imperative role in healthy female sexual function. The study suggests an interdisciplinary approach to managing FGSI, integrating psychological and sociological approaches, to better understand women's anatomy and address gendered distress.

Introduction: Penile prosthesis (PP) is one of the main approved therapies for erectile dysfunction (ED). Greater than 50 years of clinical use has led to considerable innovation in PP surgery and patient care.

Objectives: To summarize the current literature and provide updated clinical evidence to inform healthcare providers on best practices with PP.

Methods: A consensus panel was held with leading sexual medicine experts during the 5th International Consultation on Sexual Medicine (ICSM). Relevant peer-reviewed literature was reviewed with focus on research from but not limited to the last 10 years. The quality of each individual study was judged with Oxford levels of evidence (LOE) criteria, but overall LOE were not used as systematic review was not performed. The expert panel generated consensus statements based on the quality of evidence and criteria of GRADE (Grading of Recommendations Assessment, Development and Evaluation).

Results: PP provides excellent outcomes for the treatment of ED. The panel developed 35 recommendations building upon previous recommendations. Nine recommendations (4, 5, 11,13,17, 25, 26, 31, and 32) are retained without change from 2015. Twelve recommendations (1, 2, 3, 7, 9,14,16,19,21, 28, 33, and 34) change syntax to make statements more active or change details. Fourteen recommendations (6, 8, 10, 12, 15, 18, 20, 22, 23, 24, 27, 29, 30, and 35) are novel in this update.

Conclusion: Since the 4th ICSM, new evidence has emerged to guide PP use in modern sexual medicine. While multi-institutional studies are needed to improve outcomes, key challenges remain: reducing infections, enhancing devices, and improving awareness and accessibility. We recommend following 5th ICSM guidelines while emphasizing the importance of clinical judgment and shared decision-making for optimal PP outcomes.

Introduction: Sexual dysfunction has a negative influence on both human physical and psychological health across various ages and frequently results in the deterioration of quality of life for individuals and/or partners.

Objective: The objective of the study was to assess the effectiveness of cognitive behavioral therapy (CBT) for female sexual dysfunction (FSD).

Methods: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Web of Science databases from inception to January 6, 2023 (updated on April 15, 2024). The risk of bias in all included randomized controlled trials (RCTs) was assessed using the Cochrane risk of bias tool (revised version 2.0), and meta-analysis was conducted using R (version 4.2.0). We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to evaluate the certainty of the evidence.

Results: Ten RCTs involving 837 patients were included, and three RCTs were judged at high risk of bias due to missing outcome data and baseline imbalances. In the post-intervention follow-up, CBT participants showed a greater increase in FSFI scores than those receiving routine care (MD: 7.63, 95% CI: 5.25 to 10.02, GRADE: low), and greater improvement than waitlist participants (MD: 3.13, 95% CI: 0.90 to 5.35, GRADE: moderate). In the short-term follow-up (4 to 24 weeks after completion of intervention), CBT participants had a greater increase in FSFI scores than routine care (MD: 11.13, 95% CI: 0.27 to 22.00, GRADE: low) and waitlist participants (MD: 3.80, 95% CI: 1.46 to 6.14, GRADE: very low).

Conclusion: CBT can improve the clinical symptoms of patients with FSD. However, large-scale RCTs are needed in the future.

Introduction: Artificial Intelligence (AI) has witnessed significant growth in the field of medicine, leveraging machine learning, artificial neuron networks, and large language models. These technologies are effective in disease diagnosis, education, and prevention, while raising ethical concerns and potential challenges. However, their utility in sexual medicine remains relatively unexplored.

Objective: We aim to provide a comprehensive summary of the status of AI in the field of sexual medicine.

Methods: A comprehensive search was conducted using MeSH keywords, including "artificial intelligence," "sexual medicine," "sexual health," and "machine learning." Two investigators screened articles for eligibility within the PubMed and MEDLINE databases, with conflicts resolved by a third reviewer. Articles in English language that reported on AI in sexual medicine and health were included. A total of 69 full-text articles were systematically analyzed based on predefined inclusion criteria. Data extraction included information on article characteristics, study design, assessment methods, and outcomes.

Results: The initial search yielded 905 articles relevant to AI in sexual medicine. Upon assessing the full texts of 121 articles for eligibility, 52 studies unrelated to AI in sexual health were excluded, resulting in 69 articles for systematic review. The analysis revealed AI's accuracy in preventing, diagnosing, and decision-making in sexually transmitted diseases. AI also demonstrated the ability to diagnose and offer precise treatment plans for male and female sexual dysfunction and infertility, accurately predict sex from bone and teeth imaging, and correctly predict and diagnose sexual orientation and relationship issues. AI emerged as a promising modality with significant implications for the future of sexual medicine.

Conclusions: Further research is essential to unlock the potential of AI in sexual medicine. AI presents advantages such as accessibility, user-friendliness, confidentiality, and a preferred source of sexual health information. However, it still lags human healthcare providers in terms of compassion and clinical expertise.

Introduction: Priapism is a major clinical complication of sickle cell disease (SCD), with severe sexual, reproductive, and mental health impact. There are currently no consensus diagnostic biomarkers for identifying individuals with SCD at risk of priapism before its occurrence.

Objectives: To systematically review the biochemical, hematological, imaging, genetic, and rheological parameters associated with priapism occurrence among individuals with SCD.

Methods: A systematic literature search for studies investigating the association of biochemical, hematological, rheological, imaging, rheological, and genetic parameters with the occurrence of priapism in individuals with SCD was performed in the MEDLINE, Embase, and Cochrane databases, using the following terms: "priapism," "sickle cell," "biomarker," "marker," "laboratory," "radiographic," "diagnostic," and "predictive." A systematic review of the identified studies was conducted to describe the landscape of priapism-related biomarkers in individuals with SCD.

Results: A total of 358 studies were identified, of which 14 studies were eventually selected for evidence synthesis. The selected studies were published between 2005 and 2023, with authorship spanning five continents. We identified multiple clinical parameters investigated as potential biomarker candidates for their association with priapism occurrence in patients with SCD. We classified these into biochemical (lactate dehydrogenase, bilirubin, aspartate transaminase, alanine transaminase, alkaline phosphatase, nitric oxide metabolites, interleukin 6), hematological (hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin, reticulocyte count, leukocyte count), genetic (Klotho, TGFBR3, QAP1, ITGAV, LNC02537, NAALADL2), rheological (red blood cell deformability, aggregation index, augmentation index), and imaging parameters. However, the results were often contradictory and do not support the clinical application of any of the investigated parameters.

Conclusion: Several clinical and laboratory parameters have been associated with priapism occurrence in SCD; however, contradictory findings across geographical locations paint an unreliable picture of their clinical utility. Additional studies are needed to generate enough level 1 evidence in support of any of the current candidates.

Introduction: Vacuum erectile device (VED) is 1 of the main approved therapies for erectile dysfunction (ED). The introduction of phosphodiesterase type 5 inhibitor (PDE5i) for ED significantly changed the roles of VED in contemporary sexual medicine.

Objective: To provide updated clinical evidence to inform health care providers on best practices with VED.

Methods: A consensus panel was held with leading sexual medicine experts during the 5th International Consultation on Sexual Medicine (ICSM). Relevant peer-reviewed literature was reviewed with focus on research from the last 10 years, but not limited to the last 10 years. The expert panel generated consensus statements based on the quality of evidence and criteria of Grading of Recommendations Assessment, Development and Evaluation.

Results: As a primary or combination therapy for ED, VED has been shown to be successful in all populations studied, including difficult to treat cohorts, such as diabetes mellitus, spinal cord injury, and post-radical prostatectomy (RP), but long-term attrition rates are high. Available evidence has shown that VED can preserve or restore penile size for patients after RP, after incision and grafting surgery for Peyronie's disease, before and after penile prosthesis, and after other post pelvic surgeries. However, it has not demonstrated a more rapid recovery of spontaneous erectile function after RP. VED does not increase penile length for subjective short penis. Studies with female specific VED for female sexual dysfunction are very limited.

Conclusions: Since the prior 4th ICSM, more evidence is available to support the new roles of VED in contemporary sexual medicine. Research into the penile pathophysiologic changes with VED therapy and clinical outcomes for various conditions are ongoing. We encourage sexual medicine clinicians to follow the 5th ICSM recommendations, but providers should also use their own judgement and adopt shared decision making with their patients/partners when considering VED for a specific disorder.

Introduction: Anxiety, and more specifically performance anxiety, is commonly associated with sexual problems both by health professionals and clients alike. Yet, despite its strong association with sexual dysfunctions, the conceptualization and understanding of performance anxiety are seldom provided in a comprehensive and detailed manner that imparts utility for its remediation.

Objectives: Here, we offer a theoretical model for sexual performance anxiety that directly informs a clinical approach for its remediation, with the goal of better preparing clinicians who routinely work with, counsel, and treat men and women experiencing a sexual problem.

Method: We first lay a groundwork that explains the general characteristics of anxiety as a psychological construct and emotion and briefly summarize 2 overarching models that relate anxiety to performance. Then we present a theoretical model that provides a heuristic for understanding sexual performance anxiety (SPA) and review factors purported to moderate and mediate anxiety in sexual performance situations. Finally, we present a clinical approach for its remediation (SPA-R) that is directly tied to the theoretical model (SPA), specifically demonstrating how consideration of various targets in the flow chart can serve as a roadmap for addressing performance anxiety within a psychotherapeutic context.

Results: We highlight and explain each aspect of the model and delineate the connection between the model and its application, summarizing a number of key principles inherent to the therapeutic process.

Conclusion: We offer both this theoretical model and remedial clinical application not necessarily as the only or even best solution for dealing with clients suffering from sexual performance anxiety but as a challenge to stimulate both critique and further discussion, elaboration, and research on this critically important, though somewhat neglected, topic.

Introduction: Erectile dysfunction (ED) is among the most prevalent urologic issues affecting men globally, with a notably high incidence rate. It significantly impacts the quality of life of patients and their sexual partners.

Objectives: Given the increasing prevalence of ED among men in recent years, numerous pharmacotherapies have been developed to address these conditions. However, systemic drug therapies for ED are often associated with significant challenges, including drug interactions and contraindications across a wide range of medical conditions. This has prompted researchers to focus on designing drugs and dosage forms that maintain efficacy while reducing side effects, interactions, and contraindications.

Methods: Building on previous studies, this article investigates nitrates and NO-donors with a focus on their transdermal impact, strategies for enhancing therapeutic efficiency, potential local side effects, and the evaluation of various formulations.

Results: In this regard, organic nitrates such as nitroglycerin and isosorbide dinitrate and NO donors comprising volatile alkyl nitrites, linsidomine, sodium nitroprusside, and L-arginine are among good candidates for transdermal formulations of ED treatment. In the current article, the topical effects of these compounds, both alone and in combination with other drugs, have been thoroughly examined, including aspects such as their mechanism of action, effectiveness, side effects, and contraindications.

Conclusion: Based on these findings, it appears that novel formulations with enhanced absorption of these compounds could play a significant role in the treatment of ED, either as a standalone therapy or as an adjunctive treatment. Currently, most of the data are from preclinical studies and future clinical research can reveal the precise efficacy of such transdermal formulations.