Thiago P. Furtado, P. Teloken, Y. Ortega, Joseph B Narus, Natalie P Wolchasty, John P. Mulhall
BACKGROUND Intracavernosal injection therapy (ICI) is a well-established therapeutic strategy for men with erectile dysfunction. Complications are often related to patient error when performong ICI. AIM The objective of this study was to examine patient errors in an established patient training program for performing ICI and identify factors that could predict major errors. METHODS Patients enrolled in our ICI program are trained on technical aspects, and dose titration is begun. Patients are given explicit instructions during training, both verbally and in written form. Records were reviewed for men using ICI for ≥6 months. Multivariable analysis was used to define predictors of major errors. OUTCOMES Errors were listed as minor (zero-response injection, penile bruising, expired medication) and major (errors potentially leading to priapism: dose self-titration, double injecting). RESULTS Overall, 1368 patients met the inclusion criteria and were included in the analysis. The mean patient age was 66 ± 22 (range 29-91) years. Regarding education, 41% of patients had graduate-level education, 48% had college education, and 11% high school education. Mean follow-up was 3.2 ± 7.6 (range 0.5-12) years. The agents used were trimix (62%), bimix (35%), papaverine (2%), and prostaglandin E1 monotherapy (1%). At least 1 error occurred during self-administration in 42% of patients during their time in the program. Errors included zero response to medication due to technical error (8% of patients), penile bruising (34%), use of an expired bottle (18%), self-titration (5%), and double injecting (4% of patients); 12% of men committed ≥1 error during their time in the program. On multivariable analysis, independent predictors of the occurrence of a major error included: young age, graduate-level education, and <12 months of injection use. CLINICAL IMPLICATIONS To the best of our knowledge, this is the first reported study to investigate ICI errors and risk factors. The identification of factors predictive of major errors allows for more tailored and intensive training in this subset of patients. STRENGTHS AND LIMITATIONS Strengths of this study include a large patient population (1386 men) with a considerable follow-up time. Additionally, the rigorous training, education, and monitoring of the participants, as well as the use of formal definitions, enhances the accuracy and reliability of the results. Despite the strengths of the study, recall bias may be a limitation concern. CONCLUSION The majority of patients were error free, and the majority of the errors were minor in nature. Major errors occurred in <10% of patients. Younger age, graduate-level education, and less experience with ICI were independent predictors of major errors.
{"title":"Delineating patient errors in an intracavernosal injection program.","authors":"Thiago P. Furtado, P. Teloken, Y. Ortega, Joseph B Narus, Natalie P Wolchasty, John P. Mulhall","doi":"10.1093/jsxmed/qdae031","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae031","url":null,"abstract":"BACKGROUND\u0000Intracavernosal injection therapy (ICI) is a well-established therapeutic strategy for men with erectile dysfunction. Complications are often related to patient error when performong ICI.\u0000\u0000\u0000AIM\u0000The objective of this study was to examine patient errors in an established patient training program for performing ICI and identify factors that could predict major errors.\u0000\u0000\u0000METHODS\u0000Patients enrolled in our ICI program are trained on technical aspects, and dose titration is begun. Patients are given explicit instructions during training, both verbally and in written form. Records were reviewed for men using ICI for ≥6 months. Multivariable analysis was used to define predictors of major errors.\u0000\u0000\u0000OUTCOMES\u0000Errors were listed as minor (zero-response injection, penile bruising, expired medication) and major (errors potentially leading to priapism: dose self-titration, double injecting).\u0000\u0000\u0000RESULTS\u0000Overall, 1368 patients met the inclusion criteria and were included in the analysis. The mean patient age was 66 ± 22 (range 29-91) years. Regarding education, 41% of patients had graduate-level education, 48% had college education, and 11% high school education. Mean follow-up was 3.2 ± 7.6 (range 0.5-12) years. The agents used were trimix (62%), bimix (35%), papaverine (2%), and prostaglandin E1 monotherapy (1%). At least 1 error occurred during self-administration in 42% of patients during their time in the program. Errors included zero response to medication due to technical error (8% of patients), penile bruising (34%), use of an expired bottle (18%), self-titration (5%), and double injecting (4% of patients); 12% of men committed ≥1 error during their time in the program. On multivariable analysis, independent predictors of the occurrence of a major error included: young age, graduate-level education, and <12 months of injection use.\u0000\u0000\u0000CLINICAL IMPLICATIONS\u0000To the best of our knowledge, this is the first reported study to investigate ICI errors and risk factors. The identification of factors predictive of major errors allows for more tailored and intensive training in this subset of patients.\u0000\u0000\u0000STRENGTHS AND LIMITATIONS\u0000Strengths of this study include a large patient population (1386 men) with a considerable follow-up time. Additionally, the rigorous training, education, and monitoring of the participants, as well as the use of formal definitions, enhances the accuracy and reliability of the results. Despite the strengths of the study, recall bias may be a limitation concern.\u0000\u0000\u0000CONCLUSION\u0000The majority of patients were error free, and the majority of the errors were minor in nature. Major errors occurred in <10% of patients. Younger age, graduate-level education, and less experience with ICI were independent predictors of major errors.","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"114 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140659456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Trost, Daniel N Watter, Serge Carrier, Mohit Khera, F. Yafi, Helen L. Bernie, M. Ziegelmann, Tobias Köhler
BACKGROUND Penile cosmetic enhancement procedures have been performed for many years with varying success. However, they have historically been relegated to niche areas of sexual medicine, with limited data, and have not achieved mainstream adoption. More recently, the topic has been increasingly discussed within academic congresses due to availability of novel techniques, therapies, and procedures. Given their distinctive nature, the Sexual Medicine Society of North America (SMSNA) felt that it was pertinent to develop formal position statements to help guide both patients and sexual medicine providers on the current state of the scientific literature and to give recommendations for future research. AIM The study sought to provide an evidence-based set of recommendations for injection and surgical procedures designed to lengthen, augment, or otherwise cosmetically enhance the penis. METHODS A review was performed of all scientific literature listed in PubMed from inception through December 2023 relating to penile cosmetic enhancement procedures. Only invasive (injection/surgery) therapies were included due to their distinct risk-benefit profile compared with more conservative treatments (eg, vacuum erection devices, penile traction devices). Similar therapies were categorized, with pertinent data summarized and used to help create relevant position statements. All statements were expert opinion only and were based on analyses of the potential risks and benefits of the specific therapies. OUTCOMES A total of 6 position statements were issued relating to 5 distinct sexual medicine cosmetic enhancement procedures. RESULTS A consensus opinion was reached by SMSNA leadership on the state of injection/surgical penile cosmetic enhancement procedures as of 2024. Key topic areas addressed included injectable soft tissue fillers, suspensory ligament division, graft-and-flap procedures, silicone sleeve implants, and sliding/slicing techniques. Distinct recommendations were tailored to each therapy and were based solely on the current state of the literature. It is anticipated that future studies will further inform position statements and will lead to ongoing modifications. CLINICAL IMPLICATIONS The current position statements provide both patients and clinicians evidence-based, expert recommendations on best practices relating to penile cosmetic enhancement procedures. STRENGTHS AND LIMITATIONS Strengths include the use of an expert panel of sexual medicine clinicians, consensus design, and summary of existing literature. Limitations include expert opinion and limited research on the topic. CONCLUSION The current SMSNA position statements provide evidence-based, consensus opinions on the appropriate role for penile augmentation and cosmetic procedures in 2024.
{"title":"Cosmetic penile enhancement procedures: an SMSNA position statement.","authors":"L. Trost, Daniel N Watter, Serge Carrier, Mohit Khera, F. Yafi, Helen L. Bernie, M. Ziegelmann, Tobias Köhler","doi":"10.1093/jsxmed/qdae045","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae045","url":null,"abstract":"BACKGROUND\u0000Penile cosmetic enhancement procedures have been performed for many years with varying success. However, they have historically been relegated to niche areas of sexual medicine, with limited data, and have not achieved mainstream adoption. More recently, the topic has been increasingly discussed within academic congresses due to availability of novel techniques, therapies, and procedures. Given their distinctive nature, the Sexual Medicine Society of North America (SMSNA) felt that it was pertinent to develop formal position statements to help guide both patients and sexual medicine providers on the current state of the scientific literature and to give recommendations for future research.\u0000\u0000\u0000AIM\u0000The study sought to provide an evidence-based set of recommendations for injection and surgical procedures designed to lengthen, augment, or otherwise cosmetically enhance the penis.\u0000\u0000\u0000METHODS\u0000A review was performed of all scientific literature listed in PubMed from inception through December 2023 relating to penile cosmetic enhancement procedures. Only invasive (injection/surgery) therapies were included due to their distinct risk-benefit profile compared with more conservative treatments (eg, vacuum erection devices, penile traction devices). Similar therapies were categorized, with pertinent data summarized and used to help create relevant position statements. All statements were expert opinion only and were based on analyses of the potential risks and benefits of the specific therapies.\u0000\u0000\u0000OUTCOMES\u0000A total of 6 position statements were issued relating to 5 distinct sexual medicine cosmetic enhancement procedures.\u0000\u0000\u0000RESULTS\u0000A consensus opinion was reached by SMSNA leadership on the state of injection/surgical penile cosmetic enhancement procedures as of 2024. Key topic areas addressed included injectable soft tissue fillers, suspensory ligament division, graft-and-flap procedures, silicone sleeve implants, and sliding/slicing techniques. Distinct recommendations were tailored to each therapy and were based solely on the current state of the literature. It is anticipated that future studies will further inform position statements and will lead to ongoing modifications.\u0000\u0000\u0000CLINICAL IMPLICATIONS\u0000The current position statements provide both patients and clinicians evidence-based, expert recommendations on best practices relating to penile cosmetic enhancement procedures.\u0000\u0000\u0000STRENGTHS AND LIMITATIONS\u0000Strengths include the use of an expert panel of sexual medicine clinicians, consensus design, and summary of existing literature. Limitations include expert opinion and limited research on the topic.\u0000\u0000\u0000CONCLUSION\u0000The current SMSNA position statements provide evidence-based, consensus opinions on the appropriate role for penile augmentation and cosmetic procedures in 2024.","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Alarcón-Rodríguez, Rafael García-Álvarez, Rosario Fadul-Calderón, Raúl Romero-Del Rey, M. Requena-Mullor, Madelyn Read Tejada, J. García-González
BACKGROUND Female orgasmic disorder is listed in the DSM-5 and is defined as the persistent or recurrent inability to have an orgasm. Many depressed women may experience sexual dysfunction, including female orgasmic disorder. AIM The study sought to analyze the relationship between depressive disorders and attention-deficit/hyperactivity disorder (ADHD) and their influence on the development of female orgasmic disorder. METHODS A total of 221 Dominican women participated in this case-control study. The case group consisted of 107 women diagnosed with female orgasmic disorder, while the control group consisted of 114 women without any sexual dysfunction. OUTCOMES The diagnosis of ADHD was obtained from the participants' medical records, previously conducted using the DSM-5-TR criteria. The Beck Depression Inventory II was used to assess the severity of depressive symptoms in both groups. RESULTS There was a significant relationship between female orgasmic disorder and ADHD and depression. The results of multiple logistic regression indicated that the highest risk of female orgasmic disorder was observed in women with ADHD (odds ratio [OR], 4.91; 95% confidence interval [CI], 2.46-9.20; P < .001), women with severe depression (OR, 2.50; 95% CI, 1.08-6.96; P = .04), and women who had sexual intercourse that focused on penetration (OR, 2.02; 95% CI, 1.03-3.98; P = .04). CLINICAL IMPLICATIONS These findings may have important implications for the prevention and treatment of sexual disorders in women. STRENGTHS AND LIMITATIONS This design selected all diagnosed cases of female orgasmic disorder and did not select a specific subgroup. However, some limitations must be considered. This study was conducted in a single clinic, although it should be noted that it is the main clinic for the treatment of sexual dysfunction in the country. A further limitation could be that this type of study design does not allow for statements about causality to be made. CONCLUSION There is an increased risk of female orgasmic disorder in women with ADHD, with severe depression, and who engage in penetrative sex.
{"title":"The relationship between female orgasmic disorder, attention-deficit/hyperactivity disorder, and depression in Dominican women.","authors":"R. Alarcón-Rodríguez, Rafael García-Álvarez, Rosario Fadul-Calderón, Raúl Romero-Del Rey, M. Requena-Mullor, Madelyn Read Tejada, J. García-González","doi":"10.1093/jsxmed/qdae048","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae048","url":null,"abstract":"BACKGROUND\u0000Female orgasmic disorder is listed in the DSM-5 and is defined as the persistent or recurrent inability to have an orgasm. Many depressed women may experience sexual dysfunction, including female orgasmic disorder.\u0000\u0000\u0000AIM\u0000The study sought to analyze the relationship between depressive disorders and attention-deficit/hyperactivity disorder (ADHD) and their influence on the development of female orgasmic disorder.\u0000\u0000\u0000METHODS\u0000A total of 221 Dominican women participated in this case-control study. The case group consisted of 107 women diagnosed with female orgasmic disorder, while the control group consisted of 114 women without any sexual dysfunction.\u0000\u0000\u0000OUTCOMES\u0000The diagnosis of ADHD was obtained from the participants' medical records, previously conducted using the DSM-5-TR criteria. The Beck Depression Inventory II was used to assess the severity of depressive symptoms in both groups.\u0000\u0000\u0000RESULTS\u0000There was a significant relationship between female orgasmic disorder and ADHD and depression. The results of multiple logistic regression indicated that the highest risk of female orgasmic disorder was observed in women with ADHD (odds ratio [OR], 4.91; 95% confidence interval [CI], 2.46-9.20; P < .001), women with severe depression (OR, 2.50; 95% CI, 1.08-6.96; P = .04), and women who had sexual intercourse that focused on penetration (OR, 2.02; 95% CI, 1.03-3.98; P = .04).\u0000\u0000\u0000CLINICAL IMPLICATIONS\u0000These findings may have important implications for the prevention and treatment of sexual disorders in women.\u0000\u0000\u0000STRENGTHS AND LIMITATIONS\u0000This design selected all diagnosed cases of female orgasmic disorder and did not select a specific subgroup. However, some limitations must be considered. This study was conducted in a single clinic, although it should be noted that it is the main clinic for the treatment of sexual dysfunction in the country. A further limitation could be that this type of study design does not allow for statements about causality to be made.\u0000\u0000\u0000CONCLUSION\u0000There is an increased risk of female orgasmic disorder in women with ADHD, with severe depression, and who engage in penetrative sex.","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"65 s299","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. M. Pereira, L. G. O. Brito, Nina Ledger, C. Juliato, Claudine Domoney, Rufus Cartwright
BACKGROUND Female sexual dysfunction (FSD), including vaginal laxity (VL), can lead to a decrease in quality of life and affect partner relationships. AIM We aimed to investigate the associated factors of VL and FSD and their relationship with other pelvic floor disorders in a female population. METHODS This cross-sectional study was conducted at Chelsea and Westminster Hospital from July to December 2022. All women referred to clinical care at the urogynecology clinic were included. Participants were assessed according to sociodemographic and clinical aspects, the Pelvic Organ Prolapse Quantification system, sexual function, VL, sexual attitudes, sexual distress, sexual quality of life, vaginal symptoms, and pelvic floor disorders. Unadjusted and adjusted associated factors of VL and FSD were analyzed. OUTCOMES The primary outcome was the identification of the associated factors of VL and FSD in a female population, and secondary outcomes included the association between VL and pelvic organ prolapse (POP) with the questionnaire scores. RESULTS Among participants (N = 300), vaginal delivery, multiparity, perineal laceration, menopause, and gel hormone were significantly more frequent in those reporting VL (all P < .05). When compared with nulliparity, primiparity and multiparity increased the odds of VL by approximately 4 and 12 times, respectively (unadjusted odds ratio [OR], 4.26 [95% CI, 2.05-8.85]; OR, 12.77 [95% CI, 6.53-24.96]). Menopause and perineal laceration increased the odds of VL by 4 and 6 times (unadjusted OR, 4.65 [95% CI, 2.73-7.93]; OR, 6.13 [95% CI, 3.58-10.49]). In multivariate analysis, menopause, primiparity, multiparity, and POP remained associated with VL. CLINICAL IMPLICATIONS Parity, as an obstetric factor, and menopause and staging of POP, as clinical factors, were associated with VL. STRENGTHS AND LIMITATIONS The investigation of associated factors for VL will contribute to the understanding of its pathophysiology. The study design makes it impossible to carry out causal inference. CONCLUSION Menopause, primiparity, multiparity, and POP were highly associated with VL complaints in multivariate analysis.
AIMWe aimed to investigate the associated factors of VL and FSD and their relationship with other pelvic floor disorders in a female population.METHODSThis cross-sectional study was conducted at Chelsea and Westminster Hospital from July to December 2022.这项横断面研究于 2022 年 7 月至 12 月在切尔西和威斯敏斯特医院进行。所有转诊至泌尿妇科诊所接受临床治疗的女性均被纳入研究范围。研究人员根据社会人口学和临床方面、盆腔器官脱垂定量系统、性功能、VL、性态度、性困扰、性生活质量、阴道症状和盆底障碍对参与者进行了评估。结果在参与者（N = 300）中，阴道分娩、多胎妊娠、会阴裂伤、绝经和凝胶激素在报告 VL 者中的发生率明显更高（所有 P < .05）。与无阴道分娩相比，初产妇和多产妇发生 VL 的几率分别增加了约 4 倍和 12 倍（未调整的几率比 [OR]，4.26 [95% CI，2.05-8.85]；OR，12.77 [95% CI，6.53-24.96]）。绝经和会阴裂伤使 VL 的几率分别增加了 4 倍和 6 倍（未调整 OR，4.65 [95% CI，2.73-7.93]；OR，6.13 [95% CI，3.58-10.49]）。在多变量分析中，绝经、初产妇、多胎妊娠和 POP 仍与 VL 相关。结论在多变量分析中，绝经、初产妇、多产妇和 POP 与 VL 主诉高度相关。
{"title":"Associated factors of vaginal laxity and female sexual function: a cross-sectional study.","authors":"G. M. Pereira, L. G. O. Brito, Nina Ledger, C. Juliato, Claudine Domoney, Rufus Cartwright","doi":"10.1093/jsxmed/qdae042","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae042","url":null,"abstract":"BACKGROUND\u0000Female sexual dysfunction (FSD), including vaginal laxity (VL), can lead to a decrease in quality of life and affect partner relationships.\u0000\u0000\u0000AIM\u0000We aimed to investigate the associated factors of VL and FSD and their relationship with other pelvic floor disorders in a female population.\u0000\u0000\u0000METHODS\u0000This cross-sectional study was conducted at Chelsea and Westminster Hospital from July to December 2022. All women referred to clinical care at the urogynecology clinic were included. Participants were assessed according to sociodemographic and clinical aspects, the Pelvic Organ Prolapse Quantification system, sexual function, VL, sexual attitudes, sexual distress, sexual quality of life, vaginal symptoms, and pelvic floor disorders. Unadjusted and adjusted associated factors of VL and FSD were analyzed.\u0000\u0000\u0000OUTCOMES\u0000The primary outcome was the identification of the associated factors of VL and FSD in a female population, and secondary outcomes included the association between VL and pelvic organ prolapse (POP) with the questionnaire scores.\u0000\u0000\u0000RESULTS\u0000Among participants (N = 300), vaginal delivery, multiparity, perineal laceration, menopause, and gel hormone were significantly more frequent in those reporting VL (all P < .05). When compared with nulliparity, primiparity and multiparity increased the odds of VL by approximately 4 and 12 times, respectively (unadjusted odds ratio [OR], 4.26 [95% CI, 2.05-8.85]; OR, 12.77 [95% CI, 6.53-24.96]). Menopause and perineal laceration increased the odds of VL by 4 and 6 times (unadjusted OR, 4.65 [95% CI, 2.73-7.93]; OR, 6.13 [95% CI, 3.58-10.49]). In multivariate analysis, menopause, primiparity, multiparity, and POP remained associated with VL.\u0000\u0000\u0000CLINICAL IMPLICATIONS\u0000Parity, as an obstetric factor, and menopause and staging of POP, as clinical factors, were associated with VL.\u0000\u0000\u0000STRENGTHS AND LIMITATIONS\u0000The investigation of associated factors for VL will contribute to the understanding of its pathophysiology. The study design makes it impossible to carry out causal inference.\u0000\u0000\u0000CONCLUSION\u0000Menopause, primiparity, multiparity, and POP were highly associated with VL complaints in multivariate analysis.","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"4 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140707430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Kalyvianakis, I. Mykoniatis, N. Pyrgidis, P. Kapoteli, F. Zilotis, D. Hatzichristou
BACKGROUND Patients with severe erectile dysfunction (ED) remain the most challenging group in terms of available noninvasive treatment modalities. AIM The study sought to assess the role of combination therapy with low-intensity shockwave therapy (LiST) and daily tadalafil 5 mg in a highly select group of patients with severe vasculogenic ED through a double-blind, randomized trial. METHODS Forty-eight sexually active men were randomly assigned to 12 sessions of LiST 3 times weekly and tadalafil 5 mg once daily (n = 34) or sham therapy and tadalafil (n = 17) for 4 weeks. Patients were assessed at 1 and 3 months after completion of treatment. OUTCOMES Improvement of erectile function was evaluated through the International Index of Erectile Function-Erectile Function domain (IIEF-EF) or 6-item IIEF and the Sexual Encounter Profile (SEP) diary. The primary outcome was the difference between the groups in the IIEF-EF at 3 months after completion of treatment. Secondary outcomes comprised (1) the difference between the groups in the IIEF-EF at 1 month after completion of treatment, (2) the difference between the groups in the "yes" responses to question 3 of the SEP diary at 1 and 3 months, and (3) the treatment-related adverse events. The number of patients attaining a minimal clinically important difference in the IIEF-EF (improvement of at least 7 points) was also assessed. RESULTS After treatment, the absolute scores in the IIEF-EF were higher in patients receiving LiST and tadalafil vs sham therapy and tadalafil both at the 1-month (12.1 ± 2.4 vs 10.2 ± 1.7; P = .002) and at the 3-month (12.9 ± 2.1 vs 10.8 ± 1.8; P < .001) evaluation. Between the 2 groups, the proportion of "yes" responses to question 3 of the SEP diary was not statistically significant, whereas the number of patients attaining a minimal clinically important difference in the IIEF-EF was statistically significant only at the 3-month evaluation. No adverse events occurred. CLINICAL IMPLICATIONS Application of LiST in patients with severe vasculogenic ED receiving daily dose tadalafil may further improve erectile function compared with tadalafil as a stand-alone treatment on the short term. STRENGTHS AND LIMITATIONS Although we provided the first study in the field, severe vasculogenic ED was defined based on medical history and clinical examination and not based on penile ultrasound measures. CONCLUSION The combination of 12 sessions LiST 3 times weekly and daily tadalafil for 4 weeks led to a 2-point difference in the IIEF-EF compared with sham therapy and daily tadalafil among patients with severe vasculogenic ED after 1 and 3 months from completion of treatment.
{"title":"The effect of combination treatment with low-intensity shockwave therapy and daily tadalafil on severe erectile dysfunction: a double-blind, randomized, sham-controlled clinical trial.","authors":"D. Kalyvianakis, I. Mykoniatis, N. Pyrgidis, P. Kapoteli, F. Zilotis, D. Hatzichristou","doi":"10.1093/jsxmed/qdae038","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae038","url":null,"abstract":"BACKGROUND\u0000Patients with severe erectile dysfunction (ED) remain the most challenging group in terms of available noninvasive treatment modalities.\u0000\u0000\u0000AIM\u0000The study sought to assess the role of combination therapy with low-intensity shockwave therapy (LiST) and daily tadalafil 5 mg in a highly select group of patients with severe vasculogenic ED through a double-blind, randomized trial.\u0000\u0000\u0000METHODS\u0000Forty-eight sexually active men were randomly assigned to 12 sessions of LiST 3 times weekly and tadalafil 5 mg once daily (n = 34) or sham therapy and tadalafil (n = 17) for 4 weeks. Patients were assessed at 1 and 3 months after completion of treatment.\u0000\u0000\u0000OUTCOMES\u0000Improvement of erectile function was evaluated through the International Index of Erectile Function-Erectile Function domain (IIEF-EF) or 6-item IIEF and the Sexual Encounter Profile (SEP) diary. The primary outcome was the difference between the groups in the IIEF-EF at 3 months after completion of treatment. Secondary outcomes comprised (1) the difference between the groups in the IIEF-EF at 1 month after completion of treatment, (2) the difference between the groups in the \"yes\" responses to question 3 of the SEP diary at 1 and 3 months, and (3) the treatment-related adverse events. The number of patients attaining a minimal clinically important difference in the IIEF-EF (improvement of at least 7 points) was also assessed.\u0000\u0000\u0000RESULTS\u0000After treatment, the absolute scores in the IIEF-EF were higher in patients receiving LiST and tadalafil vs sham therapy and tadalafil both at the 1-month (12.1 ± 2.4 vs 10.2 ± 1.7; P = .002) and at the 3-month (12.9 ± 2.1 vs 10.8 ± 1.8; P < .001) evaluation. Between the 2 groups, the proportion of \"yes\" responses to question 3 of the SEP diary was not statistically significant, whereas the number of patients attaining a minimal clinically important difference in the IIEF-EF was statistically significant only at the 3-month evaluation. No adverse events occurred.\u0000\u0000\u0000CLINICAL IMPLICATIONS\u0000Application of LiST in patients with severe vasculogenic ED receiving daily dose tadalafil may further improve erectile function compared with tadalafil as a stand-alone treatment on the short term.\u0000\u0000\u0000STRENGTHS AND LIMITATIONS\u0000Although we provided the first study in the field, severe vasculogenic ED was defined based on medical history and clinical examination and not based on penile ultrasound measures.\u0000\u0000\u0000CONCLUSION\u0000The combination of 12 sessions LiST 3 times weekly and daily tadalafil for 4 weeks led to a 2-point difference in the IIEF-EF compared with sham therapy and daily tadalafil among patients with severe vasculogenic ED after 1 and 3 months from completion of treatment.","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"2015 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140718229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
U. Mann, Dhiraj S Bal, K. Panchendrabose, Ranveer Brar, Premal Patel
BACKGROUND The relationship between erectile dysfunction (ED) and cardiovascular (CV) events has been postulated, with ED being characterized as a potential harbinger of CV disease. Location of residence is another important consideration, as the impact of rural residence has been associated with worse health outcomes. AIM To investigate whether men from rural settings with ED are associated with a higher risk of major adverse CV events (MACEs). METHODS A propensity-weighted retrospective cohort study was conducted with provincial health administrative databases. ED was defined as having at least 2 ED prescriptions filled within 1 year. MACE was defined as the first hospitalization for an episode of acute myocardial infarction, heart failure, or stroke that resulted in a hospital visit >24 hours. We classified study groups into ED urban, ED rural, no ED urban, and no ED rural. A multiple logistic regression model was used to determine the propensity score. Stabilized inverse propensity treatment weighting was then applied to the propensity score. OUTCOMES A Cox proportional hazard model was used to examine our primary outcome of time to a MACE. RESULTS The median time to a MACE was 2731, 2635, 2441, and 2508 days for ED urban (n = 32 341), ED rural (n = 18 025), no ED rural (n = 146 358), and no ED urban (n = 233 897), respectively. The cohort with ED had a higher proportion of a MACE at 8.94% (n = 4503), as opposed to 4.58% (n = 17 416) for the group without ED. As compared with no ED urban, no ED rural was associated with higher risks of a MACE in stabilized time-varying comodels based on inverse probability treatment weighting (hazard ratio, 1.06-1.08). ED rural was associated with significantly higher risks of a MACE vs no ED rural, with the strength of the effect estimates increasing over time (hazard ratio, 1.10-1.74). CLINICAL IMPLICATIONS Findings highlight the need for physicians treating patients with ED to address CV risk factors for primary and secondary prevention of CV diseases. STRENGTHS AND LIMITATIONS This is the most extensive retrospective study demonstrating that ED is an independent risk factor for MACE. Due to limitations in data, we were unable to assess certain comorbidities, including obesity and smoking. CONCLUSIONS Our study confirms that ED is an independent risk factor for MACE. Rural men had a higher risk of MACE, with an even higher risk among those who reside rurally and are diagnosed with ED.
背景勃起功能障碍（ED）与心血管（CV）事件之间的关系已被证实，ED 被认为是 CV 疾病的潜在先兆。居住地是另一个重要的考虑因素，因为农村居住地的影响与较差的健康结果有关。目的研究患有 ED 的农村男性是否与较高的主要不良 CV 事件（MACEs）风险有关。ED 的定义是 1 年内至少开过 2 次 ED 处方。急性心肌梗死、心力衰竭或中风首次住院，且住院时间超过 24 小时，即为 MACE。我们将研究组分为城市急诊室、农村急诊室、无城市急诊室和无农村急诊室。采用多元逻辑回归模型确定倾向得分。结果ED城市组（n = 32 341）、ED农村组（n = 18 025）、无ED农村组（n = 146 358）和无ED城市组（n = 233 897）发生MACE的中位时间分别为2731天、2635天、2441天和2508天。有 ED 的组群发生 MACE 的比例较高，为 8.94%（n = 4503），而无 ED 的组群为 4.58%（n = 17 416）。与无 ED 的城市组相比，在基于反概率治疗加权的稳定时变组合模型中，无 ED 的农村组发生 MACE 的风险更高（危险比为 1.06-1.08）。农村 ED 与无农村 ED 相比，MACE 风险明显更高，且随着时间的推移，效应估计值的强度会增加（危险比为 1.10-1.74）。临床意义研究结果突出表明，治疗 ED 患者的医生需要处理 CV 风险因素，以进行 CV 疾病的一级和二级预防。结论我们的研究证实，ED 是 MACE 的独立风险因素。农村男性发生 MACE 的风险较高，而那些居住在农村并被诊断出患有 ED 的男性发生 MACE 的风险更高。
{"title":"Risk of major adverse cardiovascular events in rural vs urban settings among patients with erectile dysfunction: a propensity-weighted retrospective cohort study of 430 621 men.","authors":"U. Mann, Dhiraj S Bal, K. Panchendrabose, Ranveer Brar, Premal Patel","doi":"10.1093/jsxmed/qdae043","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae043","url":null,"abstract":"BACKGROUND\u0000The relationship between erectile dysfunction (ED) and cardiovascular (CV) events has been postulated, with ED being characterized as a potential harbinger of CV disease. Location of residence is another important consideration, as the impact of rural residence has been associated with worse health outcomes.\u0000\u0000\u0000AIM\u0000To investigate whether men from rural settings with ED are associated with a higher risk of major adverse CV events (MACEs).\u0000\u0000\u0000METHODS\u0000A propensity-weighted retrospective cohort study was conducted with provincial health administrative databases. ED was defined as having at least 2 ED prescriptions filled within 1 year. MACE was defined as the first hospitalization for an episode of acute myocardial infarction, heart failure, or stroke that resulted in a hospital visit >24 hours. We classified study groups into ED urban, ED rural, no ED urban, and no ED rural. A multiple logistic regression model was used to determine the propensity score. Stabilized inverse propensity treatment weighting was then applied to the propensity score.\u0000\u0000\u0000OUTCOMES\u0000A Cox proportional hazard model was used to examine our primary outcome of time to a MACE.\u0000\u0000\u0000RESULTS\u0000The median time to a MACE was 2731, 2635, 2441, and 2508 days for ED urban (n = 32 341), ED rural (n = 18 025), no ED rural (n = 146 358), and no ED urban (n = 233 897), respectively. The cohort with ED had a higher proportion of a MACE at 8.94% (n = 4503), as opposed to 4.58% (n = 17 416) for the group without ED. As compared with no ED urban, no ED rural was associated with higher risks of a MACE in stabilized time-varying comodels based on inverse probability treatment weighting (hazard ratio, 1.06-1.08). ED rural was associated with significantly higher risks of a MACE vs no ED rural, with the strength of the effect estimates increasing over time (hazard ratio, 1.10-1.74).\u0000\u0000\u0000CLINICAL IMPLICATIONS\u0000Findings highlight the need for physicians treating patients with ED to address CV risk factors for primary and secondary prevention of CV diseases.\u0000\u0000\u0000STRENGTHS AND LIMITATIONS\u0000This is the most extensive retrospective study demonstrating that ED is an independent risk factor for MACE. Due to limitations in data, we were unable to assess certain comorbidities, including obesity and smoking.\u0000\u0000\u0000CONCLUSIONS\u0000Our study confirms that ED is an independent risk factor for MACE. Rural men had a higher risk of MACE, with an even higher risk among those who reside rurally and are diagnosed with ED.","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"294 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shari M. Blumenstock, Kelly D. Suschinsky, Lori A. Brotto, Meredith L Chivers
BACKGROUND Models depicting sexual desire as responsive to sexual arousal may be particularly apt for women experiencing arousal or desire difficulties, and the degree to which arousal triggers desire may depend on the relationship context and desire target and timing-yet, these associations have not been directly tested among women with and without sexual interest/arousal disorder (SIAD). AIM To assess the role of SIAD status and relationship satisfaction in the associations between genital arousal and 4 types of responsive desire. METHODS One hundred women (n = 27 meeting diagnostic criteria for SIAD) in romantic relationships with men viewed a sexual film (pleasurable intimate depiction of oral sex and penile-vaginal intercourse) while their genital arousal was recorded via vaginal photoplethysmography (n = 63) or thermal imaging of the labia (n = 37). Partner and solitary desire was assessed immediately before and after the film (immediate desire) and 3 days later (delayed desire). OUTCOMES Outcomes consisted of genital response (z scored by method) and associations between genital response and responsive sexual desire. RESULTS The key difference between women with and without SIAD was not in their ability to experience genital arousal but in how their genital responses translated to responsive sexual desire. Women with SIAD actually exhibited greater genital arousal than unaffected women. Associations between genital arousal and desire were significant only for women with SIAD and depended on relationship satisfaction and desire type. For women with SIAD with low relationship satisfaction, higher arousal predicted lower immediate desire for a partner; for those with high relationship satisfaction, arousal was either positively related (vaginal photoplethysmography) or unrelated (thermal imaging of the labia) to immediate desire for a partner. Associations with other desire types were not significant. CLINICAL IMPLICATIONS Patterns of genital arousal and partner-specific responsive desire among women affected with SIAD were indicative of an avoidance model in response to heightened genital arousal, unless relationship satisfaction was high; attending to genital arousal sensations could be a means of triggering sexual desire for women with SIAD who are satisfied in their relationships. STRENGTHS AND LIMITATIONS This is one of the first sexual psychophysiologic studies to connect relationship factors to patterns of sexual response. The differing arousal assessment procedures and lack of official diagnosis may have attenuated results. The homogeneous sample and in-person session requirement limit generalizability. CONCLUSION When compared with unaffected women, women affected by SIAD may exhibit stronger arousal responses with sufficiently incentivized sexual stimuli, and the connection between their genital arousal and responsive desire for their partners may be stronger and more dependent on relationship context.
背景将性欲描述为对性唤起的反应的模型可能特别适合经历唤起或欲望困难的女性，而唤起引发欲望的程度可能取决于关系背景、欲望目标和时间--然而，这些关联尚未在患有和未患有性兴趣/唤起障碍（SIAD）的女性中进行直接测试。方法：100 名与男性有恋爱关系的女性（n = 27 名符合 SIAD 诊断标准）观看了一部性爱影片（口交和阴茎阴道性交的愉悦亲密描绘），同时通过阴道光敏传感器（n = 63）或阴唇热成像（n = 37）记录了她们的生殖器唤醒情况。结果患有 SIAD 和未患有 SIAD 的女性之间的关键差异不在于她们体验生殖器唤醒的能力，而在于她们的生殖器反应如何转化为有反应的性欲。与未受影响的妇女相比，患有 SIAD 的妇女的生殖器唤起实际上更强。生殖器唤起和性欲之间的关系仅对患有 SIAD 的女性有显著影响，并且取决于关系满意度和性欲类型。对于关系满意度较低的 SIAD 女性来说，较高的性唤起预示着较低的对伴侣的直接欲望；对于关系满意度较高的女性来说，性唤起与对伴侣的直接欲望或呈正相关（阴道摄影）或不相关（阴唇热成像）。临床意义SIAD女性患者的生殖器唤起模式和特定伴侣的反应性欲望表明，除非关系满意度很高，否则她们对生殖器唤起的反应是一种回避模式；对于关系满意的SIAD女性患者来说，关注生殖器唤起的感觉可能是引发性欲望的一种手段。优点和局限性这是第一批将关系因素与性反应模式联系起来的性心理生理学研究之一。不同的性唤起评估程序和缺乏官方诊断可能会影响研究结果。结论与未受影响的女性相比，受 SIAD 影响的女性可能会在充分激励的性刺激下表现出更强烈的唤醒反应，她们的生殖器唤醒和对伴侣的回应欲望之间的联系可能会更强，并且更依赖于关系背景。
{"title":"Genital arousal and responsive desire among women with and without sexual interest/arousal disorder symptoms.","authors":"Shari M. Blumenstock, Kelly D. Suschinsky, Lori A. Brotto, Meredith L Chivers","doi":"10.1093/jsxmed/qdae036","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae036","url":null,"abstract":"BACKGROUND\u0000Models depicting sexual desire as responsive to sexual arousal may be particularly apt for women experiencing arousal or desire difficulties, and the degree to which arousal triggers desire may depend on the relationship context and desire target and timing-yet, these associations have not been directly tested among women with and without sexual interest/arousal disorder (SIAD).\u0000\u0000\u0000AIM\u0000To assess the role of SIAD status and relationship satisfaction in the associations between genital arousal and 4 types of responsive desire.\u0000\u0000\u0000METHODS\u0000One hundred women (n = 27 meeting diagnostic criteria for SIAD) in romantic relationships with men viewed a sexual film (pleasurable intimate depiction of oral sex and penile-vaginal intercourse) while their genital arousal was recorded via vaginal photoplethysmography (n = 63) or thermal imaging of the labia (n = 37). Partner and solitary desire was assessed immediately before and after the film (immediate desire) and 3 days later (delayed desire).\u0000\u0000\u0000OUTCOMES\u0000Outcomes consisted of genital response (z scored by method) and associations between genital response and responsive sexual desire.\u0000\u0000\u0000RESULTS\u0000The key difference between women with and without SIAD was not in their ability to experience genital arousal but in how their genital responses translated to responsive sexual desire. Women with SIAD actually exhibited greater genital arousal than unaffected women. Associations between genital arousal and desire were significant only for women with SIAD and depended on relationship satisfaction and desire type. For women with SIAD with low relationship satisfaction, higher arousal predicted lower immediate desire for a partner; for those with high relationship satisfaction, arousal was either positively related (vaginal photoplethysmography) or unrelated (thermal imaging of the labia) to immediate desire for a partner. Associations with other desire types were not significant.\u0000\u0000\u0000CLINICAL IMPLICATIONS\u0000Patterns of genital arousal and partner-specific responsive desire among women affected with SIAD were indicative of an avoidance model in response to heightened genital arousal, unless relationship satisfaction was high; attending to genital arousal sensations could be a means of triggering sexual desire for women with SIAD who are satisfied in their relationships.\u0000\u0000\u0000STRENGTHS AND LIMITATIONS\u0000This is one of the first sexual psychophysiologic studies to connect relationship factors to patterns of sexual response. The differing arousal assessment procedures and lack of official diagnosis may have attenuated results. The homogeneous sample and in-person session requirement limit generalizability.\u0000\u0000\u0000CONCLUSION\u0000When compared with unaffected women, women affected by SIAD may exhibit stronger arousal responses with sufficiently incentivized sexual stimuli, and the connection between their genital arousal and responsive desire for their partners may be stronger and more dependent on relationship context.","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"31 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140735209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1093/jsxmed/qdae018.013
M. J. Coronado Villarreal, S. Fehrmann Rivera, M. J. Montenegro Gutiérrez, L. N. Peña Plazas, L. V. Ramírez Salguero, V. Sánchez Otero
In the 21st century, the transgender population begun to have greater visibility and advances within the health field in terms of gender reassignment. This transition covers four aspects which includes legal, social, surgical reassignment and hormone therapy. Although the word transgender is no longer in the disorders section, it’s still seen as a disease. For this reason, the transgender population continues to be pathologized. In Bogotá, Colombia, information on the processes that encompass gender reassignment is currently not sufficient. To understand the perception of transgender men about the four aspects of the female-to-male gender reassignment currently taking place in Bogotá. Qualitative descriptive study with biographical/narrative design carried out using semi-structured interviews were conducted with 4 transgender men over 18 years who have completed at least one of the aspects in Bogotá. These interviews were audio recorded, transcribed and analyzed. The results were divided into 2 dimensions, which were subdivided into various categories. Once gender reassignment began, most transgender men opt to start with the social aspect because it allows them to present themselves to society in their desired way. After this, they continued with the legal, hormonal and surgical aspects according to each person's preference. As a result, a lack of protocols and poor follow-up of health care guidelines for adequate care of this population were evident. No conflict.
{"title":"(O-19) GENDER REASSIGNMENT IN TRANSGENDER MEN IN BOGOTá, COLOMBIA","authors":"M. J. Coronado Villarreal, S. Fehrmann Rivera, M. J. Montenegro Gutiérrez, L. N. Peña Plazas, L. V. Ramírez Salguero, V. Sánchez Otero","doi":"10.1093/jsxmed/qdae018.013","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae018.013","url":null,"abstract":"\u0000 \u0000 \u0000 In the 21st century, the transgender population begun to have greater visibility and advances within the health field in terms of gender reassignment. This transition covers four aspects which includes legal, social, surgical reassignment and hormone therapy. Although the word transgender is no longer in the disorders section, it’s still seen as a disease. For this reason, the transgender population continues to be pathologized. In Bogotá, Colombia, information on the processes that encompass gender reassignment is currently not sufficient.\u0000 \u0000 \u0000 \u0000 To understand the perception of transgender men about the four aspects of the female-to-male gender reassignment currently taking place in Bogotá.\u0000 \u0000 \u0000 \u0000 Qualitative descriptive study with biographical/narrative design carried out using semi-structured interviews were conducted with 4 transgender men over 18 years who have completed at least one of the aspects in Bogotá. These interviews were audio recorded, transcribed and analyzed. The results were divided into 2 dimensions, which were subdivided into various categories.\u0000 \u0000 \u0000 \u0000 Once gender reassignment began, most transgender men opt to start with the social aspect because it allows them to present themselves to society in their desired way. After this, they continued with the legal, hormonal and surgical aspects according to each person's preference. As a result, a lack of protocols and poor follow-up of health care guidelines for adequate care of this population were evident.\u0000 \u0000 \u0000 \u0000 No conflict.\u0000","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"19 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140378573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1093/jsxmed/qdae018.044
B. Caiano dos Santos, L. Montagnini Mendonça, V. Cordeiro Gomes, A. Estevão, C. Nunes Silva Bahia, M. Castiglione
Pelvic radiotherapy is a treatment for gynecological and anorectal cancer, with side effects including vaginal fibrosis, dryness, adhesions and strictures. Rehabilitation aids may prevent or minimize post-radiotherapy vaginal changes and subsequent decline in sexual functioning, which could reduce distress. To present the effects of dilator therapy on vaginal changes in women with pelvic cancer undergoing radiotherapy treatment. This is an integrative review of the literature and surveys were carried out in the electronic databases PubMed and PEDro. The search terms used were: “Vaginal Dilator”, “Pelvic Neoplasm”, “Brachytherapy” and “Radiotherapy”. Only randomized clinical trials and observational studies were considered. Data collection was carried out between March and May 2022. 21 studies were found, seven of which met the established criteria and agreed with the proposed objective. Subsequently, a manual search was carried out, where two more studies were found. Finally, this review was composed of nine studies. It was observed that the vaginal dilator after radiotherapy is beneficial, reducing the frequency and severity of vaginal stenosis, thus improving the quality of sexual life of women. However, it is important to highlight that psychosocial education programs are also important and cause positive effects in this population. Strategies related to promoting treatment adherence remain necessary due to taboos related to the use of dilators. Dilator therapy is effective in reducing vaginal stenosis and improving the quality of sexual life of women undergoing radiotherapy for pelvic cancer. No conflict.
{"title":"(PM-16) DILATORY THERAPY IN WOMEN UNDERGOING RADIOTHERAPY FOR THE TREATMENT OF PELVIC CANCER","authors":"B. Caiano dos Santos, L. Montagnini Mendonça, V. Cordeiro Gomes, A. Estevão, C. Nunes Silva Bahia, M. Castiglione","doi":"10.1093/jsxmed/qdae018.044","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae018.044","url":null,"abstract":"\u0000 \u0000 \u0000 Pelvic radiotherapy is a treatment for gynecological and anorectal cancer, with side effects including vaginal fibrosis, dryness, adhesions and strictures. Rehabilitation aids may prevent or minimize post-radiotherapy vaginal changes and subsequent decline in sexual functioning, which could reduce distress.\u0000 \u0000 \u0000 \u0000 To present the effects of dilator therapy on vaginal changes in women with pelvic cancer undergoing radiotherapy treatment.\u0000 \u0000 \u0000 \u0000 This is an integrative review of the literature and surveys were carried out in the electronic databases PubMed and PEDro. The search terms used were: “Vaginal Dilator”, “Pelvic Neoplasm”, “Brachytherapy” and “Radiotherapy”. Only randomized clinical trials and observational studies were considered. Data collection was carried out between March and May 2022.\u0000 \u0000 \u0000 \u0000 21 studies were found, seven of which met the established criteria and agreed with the proposed objective. Subsequently, a manual search was carried out, where two more studies were found. Finally, this review was composed of nine studies. It was observed that the vaginal dilator after radiotherapy is beneficial, reducing the frequency and severity of vaginal stenosis, thus improving the quality of sexual life of women. However, it is important to highlight that psychosocial education programs are also important and cause positive effects in this population. Strategies related to promoting treatment adherence remain necessary due to taboos related to the use of dilators.\u0000 \u0000 \u0000 \u0000 Dilator therapy is effective in reducing vaginal stenosis and improving the quality of sexual life of women undergoing radiotherapy for pelvic cancer.\u0000 \u0000 \u0000 \u0000 No conflict.\u0000","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"104 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1093/jsxmed/qdae018.015
S Garcia, S. Peña Rodríguez, D. Fernandez Mantilla, C. Diaz Ritter
Gender-affirming hormone therapy for female-to-male transsexuals is based on testosterone administration. Testosterone therapy (TT) is associated with side effects such as arteriosclerosis and insulin resistance, among others. This review aims to synthesize the main findings in the literature regarding these adverse effects and identify gaps in knowledge that will guide future studies A systematic review of the literature was carried out with search strategies based on Mesh terms. The bibliographic databases PubMed, Embase, and SCOPUS were selected, and the following search algorithm was applied. We included clinical trials, meta-analyses, systematic reviews, and cohort studies. The articles were evaluated by three investigators, who initially reviewed the title and abstract and determined whether the article met the inclusion criteria. We followed the recommendations of the PRISMA statement for this process. The search provided a total of 93 articles (PubMed n = 61, Embase n = 2, Scopus n = 30). Four duplicates were eliminated. Finally, 22 articles met the inclusion criteria. Two studies found hematologic side effects of TT; 4 studies evidenced an increase of metabolic profile without any clinically significant side effects, 1 cohort showed an incidence of hepatic failure of 0.6% in the first year. 2 studies showed that TT was associated with endothelial disfunction and a proinflammatory state. 1 study showed an increase in body weight and lean mass and reduction in body fat. 3 studies showed that TT has no association with an increased risk of breast cancer. 1 study reported a high prevalence of acne with a highest value at 6 months post initiation of therapy. The use of TT showed side effects on metabolic profile bases without clinically significant repercussions. Additionally, even after showing endothelial damage, no cardiovascular events were reported. Further studies are required about this topic. Figure 1. Flowchart Selection of items according to PRISMA 2020. No conflict.
{"title":"(O-21) MAJOR ADVERSE EFFECTS OF ANABOLIC STEROID USE IN TRANSGENDER MEN DURING GENDER-REAFFIRMING HORMONE THERAPY: A SYSTEMATIC REVIEW OF THE LITERATURE","authors":"S Garcia, S. Peña Rodríguez, D. Fernandez Mantilla, C. Diaz Ritter","doi":"10.1093/jsxmed/qdae018.015","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae018.015","url":null,"abstract":"\u0000 \u0000 \u0000 Gender-affirming hormone therapy for female-to-male transsexuals is based on testosterone administration. Testosterone therapy (TT) is associated with side effects such as arteriosclerosis and insulin resistance, among others. This review aims to synthesize the main findings in the literature regarding these adverse effects and identify gaps in knowledge that will guide future studies\u0000 \u0000 \u0000 \u0000 A systematic review of the literature was carried out with search strategies based on Mesh terms. The bibliographic databases PubMed, Embase, and SCOPUS were selected, and the following search algorithm was applied. We included clinical trials, meta-analyses, systematic reviews, and cohort studies. The articles were evaluated by three investigators, who initially reviewed the title and abstract and determined whether the article met the inclusion criteria. We followed the recommendations of the PRISMA statement for this process.\u0000 \u0000 \u0000 \u0000 The search provided a total of 93 articles (PubMed n = 61, Embase n = 2, Scopus n = 30). Four duplicates were eliminated. Finally, 22 articles met the inclusion criteria. Two studies found hematologic side effects of TT; 4 studies evidenced an increase of metabolic profile without any clinically significant side effects, 1 cohort showed an incidence of hepatic failure of 0.6% in the first year. 2 studies showed that TT was associated with endothelial disfunction and a proinflammatory state. 1 study showed an increase in body weight and lean mass and reduction in body fat. 3 studies showed that TT has no association with an increased risk of breast cancer. 1 study reported a high prevalence of acne with a highest value at 6 months post initiation of therapy.\u0000 \u0000 \u0000 \u0000 The use of TT showed side effects on metabolic profile bases without clinically significant repercussions. Additionally, even after showing endothelial damage, no cardiovascular events were reported. Further studies are required about this topic.\u0000 Figure 1. Flowchart Selection of items according to PRISMA 2020.\u0000 \u0000 \u0000 \u0000 No conflict.\u0000","PeriodicalId":377411,"journal":{"name":"The Journal of Sexual Medicine","volume":"109 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140380560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：